摘要
目的探讨单纯Knapp手术与联合Foster缝线技术的改良Knapp手术在双上转肌麻痹（DEP）治疗中的手术效果。方法回顾性病例系列研究。收集2007年1月至2015年6月天津市眼科医院收治的DEP患者22例，其中男性9例，女性13例，年龄3～25岁。患者行Knapp斜视矫正手术或联合Foster缝线技术改良Knapp手术治疗，分析术前术后眼位、斜视度数、患眼上转和下转功能及双眼视功能的变化。非正态分布数据采用两独立样本Mann—Whitney秩和检验行组间比较、两相关样本Wilcoxon秩和检验行术前和术后比较。正态分布数据采用方差齐性检验、两独立样本间t检验、配对t检验进行统计学分析。结果单纯Knapp手术组15例，术前、术后原在位平均垂直斜视度数分别为（34．7±8．6）和（6．5±6．5）三棱镜度（PD），差异有统计学意义（t=30．41，P=0．00）。联合Foster缝线技术改良Knapp手术组7例，术前、术后原在位平均垂直斜视度分别为（38．6±14．6）和（5．7±9．3）PD，差异有统计学意义（t=15．33，P=O．00）。改良Knapp手术组垂直斜视平均矫正量为（32．9±5．7）PD，较单纯Knapp手术组的（28．1±3．6）PD显著增加（t=-2．39，P=0．03），且对眼球上转运动分级改善程度（2．8±0．5）较单纯Knapp手术（1．9±0．6）更显著，差异有统计学意义（t=2．41，P=0．02），二者对下转运动的影响程度的差异无统计学意义（U=43．00，P=0．54）。术前7例代偿头位下有双眼视功能患者，术后代偿头位消失或〈5°，于功能眼位（原在位和下方阅读）获得双眼视觉。Knapp与改良Knapp手术对DEP一次手术的治愈率为72．7％，术前原在位垂直斜视度数／〉40PD患者欠矫明显，需要二次手术。结论单纯Knapp手术与联合Foster缝线技术的改良Knapp手术均适用于下无下直肌限制因素或已经解除限制因素的DEP，均显著矫正原在位垂直斜视并改善麻痹眼上转运动，对下方阅读视野无明显影响，有助于双眼视功能的恢复。Foster缝线改良Knapp手术较单纯Knapp手术对斜视度矫正和眼球运动功能的恢复效果更加显著。
Objective To investigate the efficacy of Knapp procedure and modified Knapp procedure with Foster suture in the treatment of double elevator palsy（DEP）. Methods Retrospective study. Twenty-two patients with congenital DEP were underwent Knapp procedure （n=15） and modified Knapp procedure（n=7）. The clinical data were retrospectively analyzed, including the preoperative and postoperative vertical deviation in the primary position, ocular motility, and binocular vision. Results The average vertical deviation in the primary position was （34.7±8.6） prism diopters（PD） before surgery and （6.5± 6.5） PD after surgery （t=30.41, P=0.00） in the group underwent Knapp procedure. The mean preoperative and postoperative deviations of the group underwent modified procedure were respectively （38.6± 14.6） PD and （5.7±9.3）PD （t=15.33, P=0.00）. The mean corrected vertical deviation of the latter （32.8±5.7） PD was greater than that of the former （28.1±3.6） PD（t=-2.39, P=0.03）. The mean improved upgaze in the modifiedgroup （2.6±0.5） was more obvious than that in the Knapp group （1.9±0.6） （t=2.41, P=0.02）. There is no significant difference in the surgical effect on downgaze between two groups （U=43.00, P=0.54）. Seven patients having binocular vision with abnormal head posture （AHP） before surgery obtained binocular single vision in the primary position and reading position after operations. AHP disappeared or reduced to less than 5%. The surgical outcomes were satisfied in 72.7% patients. But the patients with 〉140 PD preoperative vertical deviation were under-corrected and needed the further operations. Conclusions Knapp procedure and modified Knapp procedure with Foster suture were the efficient procedures for treatment of DEP without restriction of ipsilateral inferior rectus. Both procedures can obviously correct the vertical deviation and improve upgaze without remarkable limitation of downgaze, which is good to obtain the binocular single vision in the primary and reading position. The modified procedure has more powerful effect on the corrected vertical deviation and improved upgaze.
出处
《中华眼科杂志》
CSCD
北大核心
2017年第12期903-907,共5页
Chinese Journal of Ophthalmology
关键词
眼肌麻痹
斜视
动眼肌
缝合技术
眼球运动
功能恢复
Ophthalmoplegia
Strabismus
Oculomotor muscles
Suture techniques
Eyemovements
Recovery of function
