rectus transposition

When the contractile force of an extraocular muscle is completely lost, general strengthening techniques, such as cutting, migratory or folding, cannot restore the rotational force of the muscle. Hummelshein (1970) designed a surgical procedure to transfer part of the function of the superior and inferior rectus muscles to the lateral rectus muscle for the treatment of IV cranial nerve anesthesia. Since then, there have been many improved methods, but the basic principle is the same, that is, in the IV cranial nerve palsy, part of the function of the superior and inferior rectus muscles is transferred to the lateral rectus muscle; when the IV cranial nerve part is paralyzed and the internal rectus muscle, the part will be partially The superior and inferior rectus muscles (normal function) are transferred to the medial rectus. Similarly, when the double upper muscles or the double lower muscles are paralyzed, the horizontal muscles are displaced. It is emphasized that mechanical traction may occur at the same time when one or more extraocular muscles are paralyzed. This traction must be confirmed by a traction test before surgery and relieved after surgery. Otherwise, muscle displacement cannot improve the eyeball. motion. Treatment of diseases: paralytic strabismus Indication 1. Complete paralysis of any of the four rectus muscles, conservative treatment for more than half a year without any improvement. Generally, the horizontal extramuscular or internal rotation should not exceed the midline or the upper and lower rectus muscles should not go up or down. 2. When the rectus muscle is cut off due to trauma, the broken end cannot be found. 3. Hematoxygenicity: The previous surgical mistake, when the eye muscles were off-line and no muscles were found. 4. Congenital absence of a rectus muscle. Contraindications 1. The function of the two rectus muscles to be displaced must be normal. For example, any one of the rectus muscles is weakened as a contraindication. 2. Antagonistic muscles of the palsy muscle should be free of severe contracture and fibrosis. If the traction test is positive, the first operation can resolve the contracted or fibrotic eye muscles, and then proceed to the next operation according to the situation. 3. Three straight muscles should not be cut in one operation, otherwise it may cause ischemia in the anterior segment of the eye. 4. After conservative treatment, the eye movement to the paralysis muscle side is improved or unstable, and treatment should continue. 5. The cause of the disease is not removed (such as cranial neuropathy). Surgical procedure 1. The original method of hummelshein is to displace the temporal half of the superior and inferior rectus tendons below the attachment point of the lateral rectus muscle. 2. Weiner method is to cut the external rectus muscle of paralysis and split the broken end into two adjacent upper rectus and inferior rectus muscles. 3. Jackson's surgical approach to solving the iii cranial nerve palsy is to break a small segment of the superior oblique muscle into the sclera near the medial rectus. 4. Beren retreats the medial rectus muscle, removes the rectus muscle, and sutures the hemifacial side of the superior and inferior rectus muscles to the excised lateral rectus muscle. 5.knapp's method is to shift the entire tendon of the inner and outer rectus muscles to the sclera of the proximal rectus muscle attachment point, or to recede the lower rectus muscle at the same time.