| 目的：探讨下斜肌减弱术在不同类型先天性麻痹性垂直斜视治疗中的效果
及手术选择的基本原则。方法：分析近2年行手术治疗的先天性麻痹性垂直斜视患者65例(82眼)，根据垂直斜视的度数分别行下斜肌断腱术（5～15°），下斜肌断腱＋转位前徙术（16～20°）和下斜肌断腱＋转位前徙联合上（下）直肌减弱（加强）术（>20°），分别简称为断腱术、转位术、联合术。结果：垂直斜视的治愈好转率达89.1％, 行断腱术者60眼，平均矫正8.33±4.25°；转位术18眼，平均矫正13.45±5.91°；联合术4眼 ， 平均矫正22.00±9.79°。术后代偿头位改善或消失的46例，下斜肌功能亢进改善或消失的66眼；术后出现同时视者22例，融合功能恢复者5 例，立体视觉恢复者3例。结论：下斜肌减弱术是治疗先天性麻痹性垂直斜视的首选术式，该术式简单易行，疗效可靠，术后早期疗效明显，有一定促进双眼单视恢复的功能。
Objective : To evaluate the therapeutic effects of diminishing the inferior oblique for congenital paralytic squint with vertical muscles palsy, and the rules of surgery design. Methods : 65patients (82 eyes) had been operated by 3 kinds of surgery: inferior oblique myectomy (IOM ,according to the vertical degree among 5～15°), anterior transposition of the inferior oblique (ATIO ,according to the vertical degree among 16～20°),and the combinated surgery with superior or inferior rectus (R&O ,according to the vertical degree >20°). Results : The cure and improve rate of vertical degree was achieved 89.1%. 60eyes had been performed IOM ,the correct degree was 8.33±4.25°;18eyes for ATIO ,the correction was 13.45±5.91°;4eyes for R&O , the correction was 22.00±9.79°.46patients had their compensatory head posture disappeared or improved. Inferior oblique overaction disappeared or improved in 66 eyes. Simultaneous perception occurred in 22 cases after surgery. There’re recovered fusion 5 cases and stereoacuity 3 cases also. Conclusion : The diminished inferior oblique is the best selection for congenital paralytic squint. This kind of operation is convenient to be performanced , the effect is reliable ,obvious and rapidly. It also can improve the biocular vision. |
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