双眼直肌后徙术与单眼直肌后徙联合对侧直肌截短术之比较  

Bilateral Rectus Recession versus Unilateral Rectus Recession Combined with the Opposite Rectus Resection

作　　者：胡凯[1] 孙建宁[1] 赵平远[1] 栾洁[1] 

机构地区：[1]东南大学附属中大医院眼科,南京210009

出　　处：《中国实用眼科杂志》2009年第5期520-522,共3页Chinese Journal of Practical Ophthalmology

摘　　要：目的评价双眼直肌后徙术与单眼直肌后徙联合对侧直肌截短术，治疗共同性基本型内斜视和基本型外斜视的效果。方法选择水平共同性斜视患者511例，斜视度数为20～50。，分成A、B两组，分别行双眼直肌后徙术、单眼一条直肌后徙＋对侧直肌截短术，再根据基本型内斜、基本型外斜及斜视度数大小不同分为：A1a、A1b、A2a、A2b、B1a、B1b、B2a、B2b计8组。总结、分析术后1月及6月的视力，眼位，眼球运动状态，有无复视，双眼单视功能，结膜局部瘢痕及平整度。结果A1a组术后6月眼球正位率显著高于B1a组（χ^2=5．49，P=0．0191）、A2a组亦高于B2a组（χ^2=9．14，P=0．0025）；Alb组术后6月眼球正位率显著低于B1b组（χ^2=7．86，P=0．0050）、A2b组亦低于B2b组（χ^2=16．76，P〈0．0001）；A组术后6月具备I级以上视功能患者比例明显高于B组（χ^2=14．81，P=0．0001）。结论无论外斜视或内斜视，对于相对低斜视度数的患者，双眼后徙术优于单眼后徙＋截短术，对于相对高斜视度数患者，单眼后徙＋截短术眼位一次矫正率高于双眼后徙术；双眼后徙术术后双眼单视功能好于单眼后徙＋截短术。Objective To evaluate the surgical effectiveness of bilateral rectus recession and unilateral rectus recession combined with the opposite rectus resection for the comitant basic esotropia and basic exotropia.Methods 511 patients of level comitant strabismus with dimensionality 20A-50A were randomly divided into group A and group B：group A：patients underwent bilateral rectus recession;group B：patients underwent unilateral rectus recession and the opposite rectus resection.They were subdivided into 8 groups which were Ala, Alb ,A2a, A2b, B1a, B1b, B2a, B2b,according to the type and the dimensionality of strabismus.Summarize the data of visual activity, position of eye, condition of ocular movement, ambiopia, bifixation and the scar of conjunctiva,which were obtained one or six monthes after surgery.Results The rate of orthophoria in group Ala was larger than that in group Bla six monthes after surgery （χ^2=5.49,P =0.0191 ）, group A2a did the same versus group B2a（χ^2= 9.14, P =0.0025 ） ;the rate of orthophoria in group A1 b was lower than that in group B lb six monthes after surgery （χ^2= 7.86, P =0.0050）, group A2b did the same versus group B2b （χ^2= 16.76, P 〈 0.0001 ） ;The rate of patients in group A who had above grade I visual function was obviously larger than that in group B （χ^2= 14.81, P =0.0001 ）.Conclusions No matter exotropia or esotropia, to patients with relatively low degrees strabismus,bilateral rectus recession was better than unilateral rectus recession and the opposite rectus resection;while to patients with relatively large degrees strabismus, the rate of orthophoria of unilateral rectus recession and the opposite rectus resection was larger than that of bilateral rectus recession.To the unction of bifixation,bilateral rectus recession was better than unilateral rectus recession and the opposite rectus resection.

关 键 词：单眼 双眼 基本型斜视 手术 

分 类 号：R778[医药卫生—眼科] R777.41[医药卫生—临床医学]