縫合が可能であった高齢者の外傷性下直筋断裂

Suturing of lacerated inferior rectus muscle in a senile person

　80歳女性が作業中にS字型の針金性フックで左眼を突き，即日来院した。左眼結膜は輪部下方で180°にわたって断裂し，左眼に高度の下転障害があり，上斜位を呈していた。ただちに手術を施行したが，下直筋の中枢側が発見できず，結膜縫合のみを行った。2日後の再手術でテノン嚢内の深部に下直筋の断端を発見し，末梢側の断端と3針縫合した。9日後に眼球運動障害は中等度に回復し，6週後には下方視での複視がほぼ消失した。外傷性外眼筋断裂では，断裂した筋の中枢側の断端を発見することが通常は困難である。本症例では，下直筋の中枢側の断端がLockwood靭帯のために後退しなかったことが，その発見と再縫合を可能にしたと考えた。

An 80-year-old woman was injured by an S-shaped iron hook in her left eye. When seen the same day, the bulbar conjunctiva was lacerated along the lower hemisphere of the corneal limbus. The left eye was displaced upward and showed severe limitation in downward gaze. We could not identify the proximal end of the lacerated interior rectus muscle during the ensuing surgery. During another surgery 2 days later, the proximal end of the muscle was found buried deep in the Tenon capsule. Both ends of the lacerated mus-cle were sutured using 3 stitches. The impaired ocular motility showed moderate recovery 9 days later. Diplo-pia during attempted downmward gaze disappeared 6 weeks after surgery. It is often difficult to identify the proximal end of lacerated rectus muscle. In the present case, resuturing of both ends of lacerated muscle was possible as its proximal end remained in the original site due to anterior traction by the Lockwood ligament.