共同性外斜视矫正手术联合下斜肌减弱术治疗儿童复杂斜视

Surgical correction of concomitant exotropia combined with inferior oblique weakening procedures for the treatment of children with complex strabismus

摘要:

目的：观察共同性外斜视矫正手术联合下斜肌减弱术治疗儿童复杂斜视的临床疗效。

方法：选取2015-01/2017-02我院收治的68例80眼复杂斜视患儿，均行共同性外斜视矫正手术，对其临床诊治进行回顾性分析，依据是否联合下斜肌减弱术治疗，分为联合组(30例35眼)与非联合组(38例45眼)，比较两组患儿手术前后视功能、5m斜视度、下斜肌亢进程度、Titmus立体试验结果，并观察两组患者术后疗效。

结果：术后6mo，两组具有同时视患者、一定融合范围患者、远立体视功能患者和近立体视正常者(40″～60″)所占比例均较术前明显升高(P<0.05)，但组间比较差异无统计学意义(P>0.05)。术后6mo，两组患儿下斜肌亢进程度、5m斜视度与术前相比得到明显改善(P<0.05)，组间比较均无统计学差异(P>0.05)； 术后1～3d，1a随访显示，两组患儿正位率、过矫率和欠矫率比较差异均无统计学意义(P>0.05)。

结论：对儿童复杂斜视采取共同性外斜视矫正手术治疗时，联合下斜肌减弱术可能不会影响外斜视矫正效果，进行手术设计时，可忽略下斜肌减弱术对患儿水平斜视度产生的影响。

Abstract:

AIM: To observe the clinical curative effect of surgical correction of concomitant exotropia combined with weakening procedures in the treatment of children with complex strabismus.

METHODS: Totally 68 children(80 eyes)with complex strabismus who were admitted to the hospital from January 2015 to February 2017 were selected. All of them were treated by surgical correction of concomitant exotropia. The clinical diagnosis and treatment were retrospectively analyzed. They were divided into the combined group(n=30, 35 eyes)and the non-combined group(n=38, 45 eyes)according to the implementation of inferior oblique weakening procedures. The visual function, 5m exotropia deviation, degree of inferior oblique muscle overreaction and results of Titmus stereoscopic experiment were compared between the two groups before and after surgery. The postoperative curative effect of both groups was observed.

RESULTS: The proportions of patients with simultaneous vision, patients with certain fusion range, patients with distant stereoscopic vision and normal patients with near stereoscopic vision(40-60s)in both groups were significantly increased surgery at 6mo after surgery(P<0.05), without significant differences between groups(P>0.05). The degree of inferior oblique muscle overreaction and 5m exotropia deviation in both groups were significantly improved at 6mo after surgery(P<0.05), but there was no significant difference between groups(P>0.05). Follow-up of 1-3d, 1a after operation showed there were no significant differences between the two groups in the orthophoria rate, over-correction rate or under-correction rate(P>0.05).

CONCLUSION: In the treatment of children with complex strabismus by surgical correction of concomitant exotropia, the combined use of inferior oblique weakening procedures may not affect the correction effects of exotropia. When the surgery is designed, the impact of inferior oblique weakening procedures can be ignored.