Jordan David R, Stoica Bazil, Dutton Jonathan J
Department of Ophthalmology, University of Ottawa Eye Institute, Ottawa Hospital, Ottawa, Ontario, Canada.
Ophthalmic Plast Reconstr Surg. 2018 Jan/Feb;34(1):31-36. doi: 10.1097/IOP.0000000000000847.
To describe the results and potential benefit of direct muscle release from the globe during enucleation surgery without identifying sutures in the rectus muscle insertion sites, a technique referred to as the hook and release technique.
Single center, retrospective chart review of patients who underwent enucleation with direct removal of the rectus muscles without identifying sutures in their insertion sites between January 2011 and September 2015 was carried out. The inclusion criteria were primary enucleation without previous strabismus surgery, retinal detachment surgery, or orbital surgery that entered the fibrous connective tissue framework. Forty charts of enucleated patients that had direct release of their extraocular muscles without identifying sutures before releasing them from the globe were identified and reviewed. The primary outcome measure was intraoperative or immediate postoperative complications. This retrospective chart review was performed with research ethics board approval and in compliance with the Declaration of Helsinki.
Data show that following the hook and release technique, the rectus muscles were easily located and reconnected to the orbital implant wrap. The oblique muscles were not reattached. In each of the 40 patients, the 4 rectus muscles were easily located by gently applying traction anteriorly at the conjunctiva/Tenons' edge using double-pronged skin hooks. There was no instance of a lost or slipped muscle following the hook and release technique.
The hook and release technique is a simple and efficient method to remove the 4 rectus muscles from the globe and still easily locate them. They are not "lost" and do not "slip out of position" but held in place by the orbital connective tissue framework and the extraocular muscle pulley system. This technique has been very helpful teaching resident staff how to do enucleation surgery as it avoids the more time consuming placement of double-armed locking sutures through the rectus muscle insertions and the potential risk of globe penetration while the muscles remain attached to the eye. If the surgeon desires to attach the muscles to the orbital implant, then sutures are passed after the eye is removed, thus eliminating the worry of globe penetration and avoiding accidentally cutting preplaced extraocular muscle sutures during the remaining enucleation procedure.
描述眼球摘除术中在不识别直肌附着点缝线的情况下直接从眼球上松解肌肉的结果及潜在益处，该技术称为钩取松解技术。
对2011年1月至2015年9月期间接受眼球摘除术且在直肌附着点未识别缝线而直接切除直肌的患者进行单中心回顾性病历审查。纳入标准为未曾接受过斜视手术、视网膜脱离手术或进入纤维结缔组织框架的眼眶手术的初次眼球摘除术。确定并审查了40例在不识别缝线的情况下直接松解眼外肌后进行眼球摘除的患者病历。主要观察指标为术中或术后即刻并发症。本次回顾性病历审查经研究伦理委员会批准，并符合《赫尔辛基宣言》。
数据显示，采用钩取松解技术后，直肌易于定位并重新连接至眼眶植入物包裹处。斜肌未重新附着。在40例患者中的每一例中，通过使用双叉皮肤钩在结膜/提上睑肌边缘向前轻轻牵拉，4条直肌均易于定位。采用钩取松解技术后未出现肌肉丢失或滑脱的情况。
钩取松解技术是一种简单有效的方法，可从眼球上移除4条直肌并仍能轻松定位它们。它们不会“丢失”也不会“滑出位置”，而是由眼眶结缔组织框架和眼外肌滑车系统固定在位。该技术在培训住院医师进行眼球摘除手术方面非常有帮助，因为它避免了通过直肌附着点放置双臂锁定缝线这一耗时的操作以及在肌肉仍附着于眼球时发生眼球穿孔的潜在风险。如果外科医生希望将肌肉附着于眼眶植入物，则在眼球摘除后穿针缝线，从而消除眼球穿孔的担忧，并避免在剩余的眼球摘除过程中意外切断预先放置的眼外肌缝线。
