目的:小角高斜视在眼球下垂综合征中可通过垂直直肌肌腱分级切开术方便治疗,然而,由于效果的可变性,建议在局部麻醉下使用可调节的技术。我们在实验模型中进行了分级肌腱切开术,以阐明对这种外科手术反应变异性的影响原因。
方法:实验研究:方法:制备具有插入性巩膜连续性的新鲜牛直肌肌柄标本32例,延伸到近端肌肉腹部的总长度为40毫米,并修剪至16mm宽度。通过夹钳将样本锚定在生理室内的巩膜插入和肌肉腹部末端。预处理后,通过线性电机施加拉伸至10%应变,使拉力稳定在平台状态。然后,随着测量残余力,逐渐对25、50、75、90、100%的边缘肌腱切开术进行渗透。
结果:肌腱平均厚度为0.29±0.05mm,宽度为19.71±2.25mm。平均而言,残余力从4.23±1.34、2.76±0.88、1.70±0.73、1.01±0.49、0.39±0.10和0N线性下降(R2=0.985),在0、25、50、75、90、100%肌腱切开术。然而,标本之间的效果存在明显的个体差异,变异系数为32、32、43、49和27%,结论:平均有一个线性关系之间的分级直肌肌切开术和百分比的力量减少,但是单个肌腱之间的影响很大,与报告的手术效果差异平行。这解释并暗示了在此过程中可调节技术的持续可取性。
OBJECTIVE: Small angle hypertropia in sagging eye syndrome is conveniently treated by graded vertical rectus tenotomy, yet an adjustable technique under topical anesthesia has been recommended because of variability of effect. We performed graded tenotomy in an experimental model to elucidate the reason for variability of response to this surgical procedure.
METHODS: Experimental study.
METHODS: Thirty-two fresh bovine rectus musculotendon specimens were prepared including continuity with insertional sclera, and extending for a total 40 mm length to the proximal muscle bellies, and trimmed to 16 mm width. Specimens were anchored by the clamps at the scleral insertion and muscle belly ends within a physiological chamber. After preconditioning and elongation to 10% strain was imposed by a linear motor, tensile force was allowed to stabilize at a plateau state. Then 25%, 50%, 75%, 90%, and 100% marginal tenotomies were performed progressively as remnant forces were measured.
RESULTS: Tendon thickness averaged 0.29 ± 0.05 mm and width 19.71 ± 2.25 mm. On average, remnant force decreased linearly (R2 = 0.985) from 4.23 ± 1.34, 2.76 ± 0.88, 1.70 ± 0.73, 1.01 ± 0.49, 0.39 ± 0.10, and 0 N, at 0%, 25%, 50%, 75%, 90%, and 100% tenotomy. However, there was marked individual variability in effect among specimens, with coefficients of variation of 32%, 32%, 43%, 49%, and 27%, respectively.
CONCLUSIONS: On average, there is a linear relationship between graded rectus tenotomy and percentage force reduction, but the effect among individual tendons is large, paralleling the reported variation in surgical effect. This explains and implies continued advisability of adjustable technique in this procedure.