直肌联结术与改良部分直肌转位术治疗完全性麻痹性内斜视的疗效比较

Efficacy comparison of Jensen and augmented Hummelsheim procedure in the treatment of complete paralytic esotropia

摘要:

目的：比较直肌联结术与改良部分直肌转位术治疗完全性麻痹性内斜视的疗效。

方法：回顾分析我院2016-10/2020-10确诊完全性麻痹性内斜视患者35例44眼，其中15例21眼行直肌联结联合拮抗肌后徙术(联结组)，20例23眼行改良部分直肌转位联合拮抗肌后徙术(转位组)。观察两组患者手术时长、手术前后原在位斜视度、外展麻痹程度、内直肌后退量及治愈率等。

结果：两组患者一般资料及手术时长均无差异(P>0.05)。术后末次随访联结组患者斜视度由102.33±41.70PD降为3.93±4.82PD(P<0.001)，外展麻痹由-4.81±0.40改善至-1.57±0.51(P<0.001)； 转位组患者斜视度由94.75±33.03PD降为2.85±5.96PD(P<0.001)，外展麻痹由-4.91±0.29改善至-1.22±0.42(P<0.001)。术后两组间斜视度比较无差异(P>0.05)，转位组较联结组外展麻痹改善佳(P<0.05)。联结组与转位组内直肌后退量分别为7.16±2.07和6.37±2.34mm(P>0.05)。术后末次随访：联结组2例欠矫(分别为+10、+12PD)，13例(87%)治愈； 转位组1例欠矫(+25PD)，19例(95%)治愈，两组间治愈率无统计学差异(P=0.565)。

结论：直肌联结术与改良部分直肌转位术能有效治疗完全性麻痹性内斜视，改良部分直肌转位术更利于改善外展麻痹。

Abstract:

AIM: To compare the efficacy of Jensen and augmented Hummelsheim procedures in the treatment of complete paralytic esotropia.

METHOD: A total of 35 patients(44 eyes)who were diagnosed with complete paralytic esotropia from October 2016 to October 2020 were retrospectively analyzed, of which 15 cases(21 eyes)underwent Jensen procedure combined with recession of antagonist muscle(Jensen procedure group), and 20 cases(23 eyes)received augmented Hummelsheim procedure combined with recession of antagonist muscle(Hummelsheim procedure group). The operation time, preoperative and postoperative esotropia deviation, degree of abduction paralysis, recession of medial rectus muscle and cure rate were observed.

RESULTS: Clinical data and operation time of the patients in two groups were not statistically significant(P >0.05). During the last follow-up, the esotropia deviation of Jensen procedure group decreased from 102.33±41.70PD to 3.93±4.82PD(P<0.001), and it decreased from 94.75±33.03PD to 2.85±5.96PD in Hummelsheim procedure group(P<0.001), while the degree of abduction paralysis were significantly improved from -4.81±0.40 to -1.57±0.51 in the Jensen procedure group(P<0.001)and from -4.91±0.29 to -1.22±0.42 in Hummelsheim procedure group(P<0.001). Besides, there was no statistical difference in postoperative esotropia deviation between the two groups(P>0.05), but the degree of postoperative abduction paralysis in the Hummelsheim procedure group was significantly better than that of Jensen procedure group(P<0.05). The recession of medial rectus muscle of the two groups were 7.16±2.07 and 6.37±2.34 mm, respectively(P>0.05). During the last follow-up, in the Jensen procedure group, 2 patients were undercorrection(+10PD and +12PD respectively)and 13 cases(87%)were cured. In the Hummelsheim procedure group, 1 patient was undercorrection(+25PD)and 19 patients were cured(95%), and there was no statistical significance in cure rates of the two groups(P=0.565).

CONCLUSIONS: Both Jensen procedure and augmented Hummelsheim procedure can effectively treat complete paralytic esotropia, and the latter is more effective in improving the abduction paralysis.