A—V型斜视合并斜肌功能异常的手术特点  

The surgical treatment of A-V patterns strabismus combined with oblique muscles abnormality

作　　者：吴夕[1] 蒋晶晶[1] 牛兰俊[1] 

机构地区：[1]北京大学人民医院眼科儿童眼病中心,北京100044

出　　处：《中国实用眼科杂志》2011年第12期1305-1308,共4页Chinese Journal of Practical Ophthalmology

摘　　要：目的探讨合并斜肌功能异常A—v型斜视的手术特点。方法120例因A—v型斜视分别行双眼上斜肌或下斜肌对称性手术、不对称性手术联合常规水平直肌后退和（或）缩短术患者，回顾性分析手术前后原在位垂直斜视度数，斜肌功能状况等。平均手术年龄12岁；平均随访时间6年。结果（1）V型斜视61例施行对称性双下斜肌减弱术，术前合并原在位垂直斜视组和不合并原在位垂直斜视组，术后原在位残余上斜视发生率分别是32．0％（8／25）和19．4％（7／36），残余上斜视3～8。A型斜视23例施行对称性双上斜肌断腱术中，术后原在位残余上斜视发生率分别是20．0％（2／10）和15．4％（2／13），术后残余上斜视角5～15。8例施行对称双上斜肌减弱术联合水平直肌垂直移位术，术后原在位残余垂直性斜视角8-15。者2例占25％。（2）V型斜视28例施行各种不对称性斜肌手术方式，术后原在位残余垂直斜视12例占42．9％，残余上斜视5～25，其中以行单侧下斜肌后徙联合对侧边缘切开术组最高，5例中有3例第二次手术施行高位眼上直肌后徙5-6mm，术后原在位残余垂直斜视角和异常头位均消失。结论施行斜肌对称性或不对称性手术治疗合并斜肌功能异常A—V型斜视，能有效地改善斜肌的功能，术后原在位残余垂直斜视总发生率27．5％，其中以下斜肌边缘切开术更为明显。Objective To investigate the surgical treatment of A-V patterns strabismus combined with oblique abnormality. Method Preand post-operative deviation and oblique muscle action were evaluated in 120 cases of A-V patterns combined with oblique muscles abnormality by symmetrical or asymmetrical bilateral superior or inferior oblique weakening procedure. The average age of surgery was 12 years old. The average following duration was about 6 years. Results Sixty-one patients were treated with symmetrical bilateral inferior oblique weakening procedure, preoperatively which included primary position vertical strabismus group and primary position vertical strabismus group. Of which 8 of 25 cases （32.0%） and 7 of 36 cases （19.4%） postoperatively remained the residual hypertropia 3 to 8 prism diopters （PD）. Twenty-three A-pattern patients were treated with symmetrical bilateral superior oblique tenectomy procedure. Of which 2 of 10 cases （20.0%） and 2 of 13 cases （15.4%） postoperatively remained the residual hypertropia 5 to 15 PD. Eight patients were treated with symmetrical bilateral superior oblique tenectomy combing transposition of horizontal rectus muscles procedure. Of which 2 cases （25.0%） postoperatively remained the residual vertical strabismus 8 to 15 PD. Twenty-eight V-pattern patients were treated with asymmetrical inferior or superior oblique weakening procedure. Of which 12 cases （42.9%） postoperatively remained the residual vertical strabismus 5 to 25 PD, and the cases which treated with unilateral inferior oblique recession combine inferior oblique marginal myotomy had the highest PD, 3 in 5 cases procedure for superior rectus muscles recession 5-6 ram, full correction residual deviation and head tilt after reoperation. Conclusions A-V patterns strabismus combined with oblique muscles abnormality can be treated with the symmetrical bilateral inferior or superior oblique weakening procedure, or asymmetrical inferior or superior oblique weakening procedure. The primary residual ver

关 键 词：A—V型斜视 斜肌手术 

分 类 号：R777.41[医药卫生—眼科]