외상으로 인해 발생한 독립된 하직근 파열 환자에서 즉각적인 수술적 치험 1예
A Case of Immediate Surgical Repair in Traumatic Isolated Inferior Rectus Muscle Rupture
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목적: 외상으로 인해 단독으로 하직근 파열이 발생한 환자에서 파열된 근육의 즉각적인 복원수술로 내림 장애의 호전과 제일안위에서 정위를 보였기에 이를 보고하고자 한다. 증례요약: 47세 남자 환자가 고압호스의 금속 부위에 맞아 생긴 우측 안검 좌상, 결막열상을 주소로 응급실에 내원하였다. 제일 안위에서 20프리즘 우안상사시를 보였으며, 하방 주시시 30프리즘 우안상사시 및 -4의 하전기능 장애가 관찰되었다. 이를 교정하기 위해 파열된 하직근의 일부를 테논을 포함한 주변조직과 함께 하직근 부착부위에 봉합하였다. 술 후 1일째에 안구의 위치는 제일안위에서 정위였고, 하방주시시 8프리즘 우안상사시가 관찰되었다. 술 후 40일째에 안구의 위치는 제일안위에서 정위였으며, 하방 주시시 4프리즘의 우안상사시를 보였다. 하전기능 장애는 -1로 호전되었다. 결론: 외상으로 완전히 하직근이 절단된 환자에서 즉각적인 복원수술로 안구운동장애의 교정과 제일안위에서 정위를 얻을 수 있었다.
Abstract
Purpose: We report a case of infraduction limitation improvement and orthotropia at primary position in a patient with traumatic isolated inferior rectus muscle rupture after immediate repair surgery of the ruptured muscle. Case summary: A 47-year-old man came to our emergency department complaining of right eyelid contusion and conjunctival laceration after trauma due to the metal part of a high pressure hose. Right hypertropia of 20 prism diopters was observed at primary gaze and right hypertropia of 30 prism diopters was observed at down gaze. The right eye showed a -4 infraduction limitation. We sutured the distal part of the ruptured inferior rectus muscle with surrounding tissue, including the Tenon’s capsule and the part of the muscle stump, to its original insertion. Orthotropia at primary position and 8-prism-diopters of right hypertropia on down gaze was observed one day after surgery. At 40 days after surgery, the patient had orthotropia at primary position and 4-prism-diopter right hypertropia on down gaze. Infraduction limitation of the right eye improved to -1. Conclusions: Immediate repair of complete traumatic isolated inferior rectus muscle rupture can correct the limitation of extraocular movement and achieve orthotropia at primary position.
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