本文選題：先天性上斜肌麻痹　切入點：手術　出處：《山東大學》2012年碩士論文

【摘要】：目的： 探討不同手術方式治療先天性上斜肌麻痹的療效,進一步明確各種術式的適用范圍。 方法： 對2007年5月至2011年6月于我院行手術治療的189例(232眼)先天性上斜肌麻痹的患者,根據術前檢查設計不同的手術方式,分別行A組下斜肌斷腱術、B組下斜肌部分切除術、C組下斜肌徙后術、D組一眼下斜肌斷腱術另一只眼下斜肌部分切除術、E組一眼下斜肌部分切除術另一眼下斜肌延長術、F組健眼下直肌徙后術、G組下斜肌減弱聯(lián)合直肌的手術。 結果： 術后觀察2-24個月,A組6例下斜肌斷腱術：4例代償頭位消失(66.67%),2例(33.33%)代償頭位明顯減輕；5例(83.33%)眼位為正位,1例(16.67%)眼位較前好轉；6例(100%)畢氏征陰性；治愈5例(83.33%),好轉1例(16.67%)；平均矯正垂直斜視9.01±4.13△。B組142例下斜肌部分切除術(合并水平斜視29例)：130例(91.55%)代償頭位消失,12例(8.45%)代償頭位明顯減輕；124例(87.32%)眼位為正位,18例(12.68%)眼位較前好轉；142例(100%)畢氏征陰性；治愈131例(92.25%),好轉11例(7.75%)；平均矯正垂直斜視12.75±4.98△。C組3例下斜肌徙后術：2例(66.67%)代償頭位消失,1例(33.33%)代償頭位明顯減輕；2例(66.67%)眼位為正位,1例(33.33%)眼位較前好轉；3例(100%)畢氏征陰性；治愈2例(66.67%),好轉1例(33.33%)；平均矯正垂直斜視13.15±5.06△。D組15例一眼下斜肌斷腱另一眼斜肌切除術(水平斜視11例)：13例(86.67%)代償頭位消失,2例(13.33%)代償頭位明顯減輕；12例(80.00%)眼位為正位,3例(20.00%)眼位較前好轉；15例(100%)畢氏征陰性；治愈13例(86.67%),好轉2例(13.33%)。E組5例一眼下斜肌切除術另一眼下斜肌延長術：4例(80.00%)代償頭位消失,1例(20.00%)代償頭位明顯減輕；4例(80.00%)眼位為正位,1例(20.00%)眼位較前好轉；5例(100%)畢氏征陰性；治愈4例(80.00%),好轉1例(20.00%)。F組8例下直肌徙后術(合并水平斜視2例)：7例(87.50%)代償頭位消失,1例(12.50%)代償頭位明顯減輕；6例(75.00%)眼位為正位,2例(25.00%)眼位較前好轉；8例(100%)畢氏征陰性；治愈7例(87.50%),好轉1例(12.50%)G組10例下斜肌合并其他直肌手術：8例(80.00%)代償頭位消失,2例(20.00%)代償頭位明顯減輕；7例(70%)眼位為正位,3例(30%)眼位較前好轉；10例(100%)畢氏征陰性；治愈8例(80%),好轉2例(20%)�？傊斡�168例(88.88%),好轉21例(11.12%)�？傆行蕿�100%。 結論： 手術治療先天性上斜肌麻痹療效確切。手術方式選擇的總原則為減弱直接拮抗肌和／或配偶肌,加強麻痹肌。根據術前檢查選擇不同手術方式可獲得較高的治愈率,減少再次手術的風險。單眼下斜肌減弱術矯正垂直斜視度數的效果為下斜肌部分切除術下斜肌斷腱術,下斜肌徙后術下斜肌斷腱術,下斜肌部分切除術與下斜肌徙后術差異無顯著性。
[Abstract]:Objective:To explore the therapeutic effect of different surgical methods for congenital superior oblique palsy and to further clarify the scope of application of various surgical methods.Methods:From May 2007 to June 2011, 189 patients (232 eyes) with congenital superior oblique palsy underwent surgical treatment in our hospital.Partial resection of inferior oblique muscle in group A and partial resection of inferior oblique muscle in group B and partial resection of inferior oblique muscle in group D and partial resection of inferior oblique muscle in group EOperation of inferior oblique muscle combined with rectus muscle in G group.Results:The eye position was better in 142 cases than that in the anterior group (n = 100) Bi's sign was negative;Two cases were cured and 1 case was improved. The average correction of vertical strabismus was 13.15 鹵5.06 .D group (15 cases with inferior oblique tendon amputated another eye oblique muscle resection (11 cases with horizontal strabismus, 13 cases with 86.67 cases)), the compensatory head position disappeared in 2 cases (13.33%) and the compensatory head position significantly decreased in 12 cases (80.005%).The ocular position was better in 15 cases than that in the anterior position (15 / 100) and the Bi's sign was negative in 3 cases with positive position and 20.00% (P < 0.05).Eight cases were cured and 2 cases were improved.168 cases were cured, 21 cases improved 11.12%.The total effective rate is 100.Conclusion:Surgical treatment of congenital superior oblique paralysis is effective.The general principle of operation was to weaken the direct antagonistic muscle and / or spousal muscle and to strengthen the paralytic muscle.According to the preoperative examination, different operative methods can obtain higher cure rate and reduce the risk of reoperation.The results showed that partial resection of inferior oblique muscle, inferior oblique muscle recession, partial resection of inferior oblique muscle and inferior oblique muscle recession had no significant effect on correction of vertical strabismus.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R779.6

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