摘要
目的探讨治疗以水平面转为主的先天性眼球震颤混合型代偿头位的手术矫正方法。设计回顾性病例系列。研究对象2003-2008年在河北省邢台眼科医院接受治疗的以水平面转为主的先天性眼球震颤混合型代偿头位的患者11例。方法采用后退双眼慢相侧的一对配偶肌(内直肌后退6mm,外直肌后退8mm),同时加强快相侧的一对配偶肌(外直肌缩短9mm,内直肌缩短7mm)的手术方法。术后随访6～20个月。主要指标双眼正前方注视视力,水平面转、下颌上抬或内收、头倾的程度。结果术后最后一次随访时双眼正前方注视最佳矫正视力提高均≥2行。术后混合型代偿头位完全消失或≤10°者9/11例,其中1例头位过矫。代偿头位扭转角≤15°者1例,仍残留25°水平面转头位者1例。结论通过单纯的减弱和加强水平肌肉的后退缩短手术进行中间带移位即可明显改善水平面转为主的先天性眼球震颤的混合性代偿头位,并能提高正前方双眼视力。
Objective To evaluate the surgical effect for congenital nystagmus （CN） with an abnormal head position in all three axes of a predominant head turn. Design Retrospective case series. Parlicipants l 1 patients with horizontal nystagmus and abnormal head position treated in Xingtai Eye Hospital during 2003-2008. All had an abnormal head position in all three axes with a predominant head turn. Methods Recession of the yoke muscles responsible for the slow phase of nystagmus （one medial rectus of 6mm, and one lateral rectus 8 mm）, and simultaneously resection of the yoke muscles responsible for the fast phase of nystagmus （the other lateral rectus 9 mm, and medial rectus 7 mm） were performed. The follow-up was from 6 to 20 months. Main Outcome Measures The visual acuity of both eyes in primary position, the degree of head turn, chin elevation or depression, head tilt. Results At the last follow-up, the all 11 patients undergoing the operation for CN gained two or more lines of Snellen acuity with both eyes in primary position for being corrected best. The postoperative mixed head position of 9 cases got disappear or ≤° 10% Of 1 ease developed overcorrection of the head turn. 1 case has the head turn of ≤ 15°, and 1 case remained the head turn of 25°. Conclusion Recessions and resections of the horizontal yoke rectus muscles in nystagmus with blockage position, when the head turn predominates over the vertical and torsional components, are effective in diminishing the abnormal head position on all three axes, and improve the visual acuity with both eyes in primary position. （Ophthalmol CHN, 2009, 18： 275-278）
出处
《眼科》
CAS
2009年第4期275-278,共4页
Ophthalmology in China
