摘要
目的 探讨上斜肌分级悬吊术治疗上斜肌亢进（SOOA）A型斜视的临床疗效和手术安全性.方法 回顾性系列病例研究.分析天津市眼科医院2011年2月至2013年3月收治SOOA的A型斜视患者15例（28只眼）行上斜肌分级悬吊术的术前术后临床资料.根据SOOA程度不同行上斜肌分级悬吊术,亢进＋4则上斜肌悬吊8～10 mm,亢进＋3则悬吊6～8 mm,亢进＋2悬吊5～6 mm,亢进＋1悬吊4 mm.术前术后眼球运动检查评价对SOOA矫正效果;术前术后三棱镜＋遮盖检查正前方和上下转25°的水平斜视度,评价对A型斜视的矫正效果;眼底照相评价对客观眼球旋转的影响.正态分布数据采用配对t检验,非正态分布数据采用Wilcoxon秩和检验组间比较,Spearman秩相关检验分析两变量间相关性.结果 共15例（28只眼）行上斜肌悬吊术（8±2）mm（4～10 mm）,并联合水平直肌手术矫正原在位水平斜视.其中2例行单眼上斜肌悬吊术,13例双眼上斜肌悬吊术.全部患者术后A型斜视消失.13例双眼上斜肌悬吊术者,术前、术后上转与下转25°水平斜视的差别分别为（24.5±11.9）、（3.2±4.2） PD（t=8.01,P=0.00）,平均A型斜视矫正量为（21.3±10.3）PD.28只眼术前、术后平均SOOA程度分别为＋3.0±2.0、＋0.5±1.0,差异有统计学意义（Z=-4.70,P=0.00）,仅1例术后残留SOOA＋2.0.眼底照相采用SigmascanPro5.0进行客观性旋转度数的测量（穿过视乳头中心的水平线为基准线,黄斑中心-视乳头中心间的连线与其夹角）,28只眼术前、术后客观内旋转度分别为＋5.4°±3.9°、＋0.3°±5.6°（t=5.76,P=0.00）,旋转矫正量为5.2°±4.8°.术前SOOA程度与术前客观性内旋度有相关性（Spearman相关系数=0.47,P=0.01）.每只眼的上斜肌悬吊手术量与客观旋转矫正度数无相关性（Spearman相关系数=0.17,P=0.39）,但与术前眼底照相的客观性内旋相关（Spearman相关系数=0.44,P=0.02）.13例双眼手术者,双眼上斜肌悬吊的总量与A型斜视矫正量无相关性（Spearman相关系数=0.55,P=0.05）.术后无一例出现继发性上斜肌麻痹和续发V型斜视改变.结论 上斜肌悬吊术可完全矫正轻中度SOOA的A型斜视,并有效矫正客观内旋,无继发上斜肌麻痹并发症,是一种安全可靠的上斜肌减弱术.
Objective To investigate the effect and safety of the graduated ＂hang-back＂ recession of superior oblique （SO） in treatment of A-pattern strabismus with superior oblique overaction （SOOA）.Methods Retrospective study.The clinical data of 15 cases （28 eyes）,who underwent graduated ＂hangback＂ recession of SO depending on the scales of SOOA,were collected and analyzed.The principle we carried on was hang-back recession 8-10mm for SOOA＋4,6 to 8 mm for SOOA＋3,5 to 6 mm for SOOA ＋2 and 4 mm for SOOA ＋ 1.The pre-operative and post-operative outcomes,including the ocular alignment,ocular motility,A-pattern and objective torsion demonstrated by fundus photographs were evaluated and compared.Results In 15 cases （28 eyes）,2 cases had unilateral hang-back recession of SO for unilateral SOOA.Thirteen cases had bilaterally symmetric or asymmetric hang-back procedure.All the patients had no A pattern after surgery.The average difference of pre-and post-operative A-patterns were （24.5± 11.9） PD and （3.2±4.2） PD in 13 cases with bilateral SOOA （t=8.01,P=0.00）.The bilateral SO hang-back procedure could correct A-pattern in an amount of 21.3± 10.3 PD in average.The average amount of pre-and postoperative SOOA were ＋3.0±2.0 and ＋0.5± 1.0 in 28 eyes （Z=-4.70,P=0.O0）.Only 1 case remained residual SOOA ＋ 2.0.Fundus photos were measured by SigmascanPro5.0 program and the average pre-and postoperative torsion were ＋5.4°±3.9°and ＋0.3°±5.6° （The baseline was the line across the center of optic disc.The torsional angle was measured between the line across the fovea and and the line across the center of optic.） in 28 eyes （t=5.76,P=0.00）.The average corrected torsion was 5.2°±4.8°.The pre-operative SOOA was related with the pre-operative torsion （Spearman correlation coefficient=0.47,P=0.01）.The surgical amounts in 28 eyes were various from 4 to 10 mm （8±12 mm in average）,which were not related with the corrected torsion （Spearman correlation coefficient=0.17,P=0.39）,but related with pre-operative torsion （Spearman correlation coefficient=0.44,P=0.02）.The total amounts on both eyes in patients operated by bilateral SO hang-back procedure were also not related with the corrected A-pattern （Spearman correlation coefficient=0.55,P=0.05）.No case had secondary SO palsy and V-pattern after surgery.Conclusions The graduated ＂ hang-back ＂ recession of SO is optional for treatment of mild to moderate SOOA and A-pattern.It corrected objectively in-torsion without risks of secondary SO palsy and V-pattern.It is a safe and effective SO weakening procedure.
出处
《中华眼科杂志》
CAS
CSCD
北大核心
2016年第8期579-583,共5页
Chinese Journal of Ophthalmology
关键词
斜视
动眼肌
眼外科手术
Strabismus
Oculomotor muscles
Ophthalmologic surgical procedures
