三种不同下斜肌减弱术治疗单侧上斜肌麻痹的手术效果。
Surgical outcomes of three different weakening procedures of inferior oblique muscle in the treatment of unilateral superior oblique palsy.
作者信息
Farid Mohamed F, Anany Mohamed, Abdelshafy Marwa
机构信息
Department of ophthalmology Benha University, 1 El Amira Fawzya st., El Vilal, Benha, Egypt.
出版信息
BMC Ophthalmol. 2020 Jul 20;20(1):298. doi: 10.1186/s12886-020-01568-w.
BACKGROUND
To compare surgical outcomes and complications of three inferior oblique weakening procedures; Inferior Oblique Myectomy (IOM), Inferior Oblique combined Resection-Anterior Transposition (IORAT) and Inferior Oblique Anterior Transposition (IOAT) in the management of unilateral Superior Oblique (SO) palsy.
METHODS
Retrospective review of medical records of all patients with unilateral SO palsy who underwent one of the aforementioned IO weakening procedures at Benha University hospital was performed. Patients were excluded if surgery was bilateral or combined with other vertical muscle surgery. Primary outcome parameters were improvement of Hypertropia (HT) in primary gaze, side gazes, on alternate head turn, Inferior Oblique Overaction (IOOA), Superior Oblique Underaction (SOUA), correction of head tilt and postoperative complications.
RESULTS
The review reveals a total of 65 patients with unilateral SO palsy; 54 congenital and 11 acquired, who met the study criteria and were classified into 3 groups; IOM group (24cases), IORAT group (19cases) and IOAT group (22cases). Compared with IOM, both IORAT and IOAT induced significant correction of HT in primary position, ipsilateral gaze, contralateral head tilt and IOOA. IORAT was significantly more effective than IOAT in correction of HT in ipsilateral gaze and contralateral head tilt while there was no statistical difference between the three groups in correction of HT in ipsilateral gaze, contralateral head tilt and SOUA. Postoperative Anti-elevation was significantly recorded following IORAT (6 cases, 31%) than IOAT (3 cases, 13%) and IOM (one cases, 4%).
CONCLUSIONS
The IORAT and IOAT were more superior to IOM in correction of IOOA and HT in the primary position and some other gaze positions. However, superiority of IORAT over the other two procedures should be weighed against its significant association with postoperative underaction of IO muscle and anti-elevation syndrome.
背景
比较三种下斜肌减弱手术（下斜肌切除术（IOM）、下斜肌联合切除术-前徙术（IORAT）和下斜肌前徙术（IOAT））在单侧上斜肌麻痹治疗中的手术效果和并发症。
方法
对在本哈大学医院接受上述下斜肌减弱手术之一的所有单侧上斜肌麻痹患者的病历进行回顾性研究。如果手术是双侧的或与其他垂直肌手术联合进行，则排除这些患者。主要结局参数包括原在位、侧方注视、交替性头位转动时上斜视（HT）的改善情况、下斜肌亢进（IOOA）、上斜肌功能不足（SOUA）、头位倾斜的矫正情况以及术后并发症。
结果
该回顾共纳入65例符合研究标准的单侧上斜肌麻痹患者，其中54例为先天性，11例为后天性，分为3组：IOM组（24例）、IORAT组（19例）和IOAT组（22例）。与IOM相比，IORAT和IOAT在原在位、同侧注视、对侧头位倾斜和IOOA方面均能显著矫正HT。在同侧注视和对侧头位倾斜的HT矫正方面，IORAT比IOAT显著更有效，而在同侧注视、对侧头位倾斜和SOUA的HT矫正方面，三组之间无统计学差异。IORAT术后显著出现上转受限（6例，31%），高于IOAT（3例，13%）和IOM（1例，4%）。
结论
IORAT和IOAT在矫正原在位和其他一些注视位的IOOA和HT方面优于IOM。然而，IORAT相对于其他两种手术的优势应与其与术后下斜肌功能不足和上转受限综合征的显著关联相权衡。
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