论文部分内容阅读
目的探讨垂直分离性斜视(DVD)与麻痹性垂直斜视合并存在的临床特点、治疗原则并观察其手术疗效。方法回顾530例DVD手术病例,分析其中合并麻痹性垂直斜视病例的临床特点、手术方法及疗效。结果530例DVD中合并麻痹性垂直斜视者106例(20%),其中单眼上斜肌麻痹者伴同侧DVD86例(16.23%);双下转肌麻痹伴同侧DVD7例;下直肌麻痹伴同侧DVD2例;双上转肌麻痹伴对侧眼DVD2例;上直肌麻痹伴对侧眼DVD8例;固定性下斜视伴对侧眼DVD1例。两者伴发的特点:原在位垂直斜视;遮盖后高位眼上斜视加大且不稳定,低位眼遮盖后也可能上飘;单眼运动有确切的眼外肌麻痹及亢进。手术疗效:满意:87.6%;改善:12.4%;无效:0。结论DVD可与麻痹性垂直斜视合并存在,两者伴发的治疗原则是单眼麻痹性上斜视合并DVD时可同期手术,麻痹性下斜视合并对侧眼DVD,一般须先行下斜眼手术。
Objective To investigate the clinical features and treatment principles of vertical separation strabismus (DVD) and paralytic vertical strabismus and to observe its curative effect. Methods 530 cases of DVD surgery were retrospectively analyzed. The clinical features, surgical methods and curative effects of the cases with paralytic vertical strabismus were analyzed. Results Among 530 DVD cases, 106 cases (20%) had paralytic vertical strabismus, among which monocular superior oblique muscle paralysis was accompanied by ipsilateral DVD86 cases (16.23%), double inferior transmuscular paralysis with ipsilateral DVD7 cases, inferior rectus paralysis with ipsilateral DVD2 cases; double upper arm muscle paralysis with contralateral eye DVD2 cases; upper rectus paralysis with contralateral eye DVD8 cases; fixed inferior strabismus with contralateral eye DVD cases. The characteristics associated with both: the original position of vertical strabismus; cover after high strabismus increased and unstable, low eye may also float on the cover; monocular movement with the extraocular muscle paralysis and hyperthyroidism. Surgical efficacy: satisfaction: 87.6%; improvement: 12.4%; invalid: 0. Conclusions The combined treatment of DVD and paralytic vertical strabismus may be associated with the principle that the treatment is associated with monocular paralytic upper strabismus with simultaneous DVD operation. Paralytic inferior oblique strabismus with contralateral DVD may be associated with oblique surgery.