儿童先天性垂直性斜视的手术治疗  

Surgical Treatment of Children's Congenital Vertical Strabismus.

作　　者：许江涛[1] 

机构地区：[1]昆明市儿童医院眼科,650034

出　　处：《中国斜视与小儿眼科杂志》2005年第4期149-152,共4页Chinese Journal of Strabismus & Pediatric Ophthalmology

摘　　要：目的探讨垂直性斜视的手术方式的选择,评价多种不同垂直性斜视手术方法的效果。方法根据术前诊断和眼外肌功能的情况单独远用或不同组合运用下斜肌减弱术、下斜肌后徙移位术、上直肌减弱术、上直肌截除术、下直肌后徙术、下直肌截除术、上斜肌断腱术、上斜肌腱折叠术。部分患者同时或分次进行了水平斜视矫正手术。结果本组117例中,术后正位102例(87．18％),欠矫13例(11．11％),过矫2例(1．70％)。术前有代偿头位的57例中,术后头位消失50例(87．72％),减轻6例(10．53%),无变化1例(1．75％)。术前57例有双眼单视功能(49．14％),术后增至99例(85．34％)(P<0．001);术前28例有立体视(24．13％),术后增至60 例(51．72％)(P<0．01)。结论良好的手术效果有赖于准确的论断和正确的手术没计。根据需要可以对原在位垂直斜视度<10△的患者进行手术,但如为垂直直肌的手术应尽量在局麻下手术。Objective Discussion for choice of manner of surgery about vertical strabismus and evaluation for effect of surgery treatment method for different vertical strabismus are shown in the paper. Methods There are eight surgical ways i.e. weakening procedure of inferior oblique muscle, anterior transposition of inferior oblique muscle, weakening procedure of the superior rectus, shortening procedure of the superior rectus, recession of the inferior rectus, shortening procedure of the inferior rectus, tenotomy of the superior oblique and tucking of the superior oblique. According to diagnoses and function of extraocular muscles before operation these ways can be used separately or can be used by combining with two or three together. Results There are 117 cases in this paper. 102cases （87.18%） have been straight in primary position; 13 cases （11.11%） have been under corrected; 2 cases （1.70%） have been over corrected after operation. In 57 cases with compensatory head posture before operation the head of 50 cases （87.72%） have not tilted and compensatory head posture of 6 cases （10.53%） have been corrected partly. After operation the cases with binocular vision have increased from 57 cases （49.14%） to 99 cases （85.34%） （P〈0.001） and the cases with stereoscopic vision have increased from 28 cases （24.13%） to 60 cases （51.72%） （P〈0.01） . Conclusions The effect of surgery depends on correct diagnosis and choice of surgical way. According to need the surgery can be done for the cases with primary position vertical strabismus angle〈10△, but the surgery can be done to the best of our abilities with local anaesthesia when we do vertical rectus surgery.

关 键 词：儿童 垂直斜视 手术治疗 

分 类 号：R779.6[医药卫生—眼科]