眼外肌调整缝线联合拮抗肌折叠术在先天性内斜视的临床应用  

Adjustable suture of rectus muscle combined rectus liner tucking for congenital esotropia

作　　者：樊云葳[1] 吴倩[1] 于刚[1] 曹文红[1] 

机构地区：[1]北京儿童医院眼科,100045

出　　处：《中国斜视与小儿眼科杂志》2012年第2期I0001-I0005,共5页Chinese Journal of Strabismus & Pediatric Ophthalmology

摘　　要：目的探讨眼外肌调整缝线联合拮抗肌折叠术矫正先天性内斜视的临床疗效。方法2005年9月至2010年1月在北京儿童医院对102例先天性内斜视（1—4岁）患儿实施眼外肌调整缝线联合拮抗肌折叠术。所有患儿均为阿托品散瞳屈光矫正后检查术前远、近三棱镜斜视度以及术后三棱镜斜视度。所有患儿均需行两条及三条肌肉手术，即主斜眼的内直肌后徙＋外直肌折叠术，对于大于35°者选择主斜眼的内直肌后徙＋外直肌折叠术＋另一眼的内直肌后徙术，其中后徙直肌均加用调整缝线技术。分别检查记录术前、术后2周、术后1月、术后6月、术后1年的斜视度变化并加以比较。采用均数±标准差（s）及配对t检验对计量资料进行分析。结果术前检查戴镜斜视度33cm及6M分别为＋58．43^△±6．5^△、＋54．21^△±5．4^△，术后2周检查斜视度分别为＋6．13^△±3．2^△、±4．13^△±2．8^△。术后1个月、6个月及1年的33cm斜视度分别为＋4．79^△±3．6^△、±2．75^△±4．3^△、±2．13^△±4．1^△。术前斜视度与术后2周斜视度比较（P〈0．001），差异有显著统计学意义。而术后1个月、6个月、1年分别与术后2周比较，均无显著性差异（P〉0．05）。术后3天内欠矫14例，过矫11例，调整率24．5％。术后2周正位101例，正位率99％。过矫1例，过矫率1％。结论眼外肌调整缝线联合拮抗肌折叠术矫正先天性内斜视，其手术安全可靠，操作简便时间短，术后早期正位率高，手术效果肯定：Objective To observe clinical effect of adjustable suture of rectus muscle combined rectus liner tucking for congenital esotropia. Methods The surgery effects of 102 cases of congenital esotropia（years from 1 to 4） in Beijing Children Hospital between 2005 to 2010. The angle of near and far deviation in primary position were measured with alternate prism cover after refraction correction test pre-and post-surgery all of children. The meth- ode of operation including adjustable suture of rectus muscle combined rectus liner tucking. The surgery effects were compared on lw, lm, 6m and ly post operation. Results The triangular prism inspection of 33cm and 6m was ＋58.43^△±6.5^△、＋54.21^△±5.4^△pre-surgery and ＋6.13^△±3.2^△、±4.13^△±2.8^△.post-surgery. The triangular prism inspection of 33cm was ＋4.79^△±3.6^△、±2.75^△±4.3^△、±2.13^△±4.1^△in lm, 6m, ly post-surgery. There was signifi- cant statistical difference between pre-and post-surgery （P〈0.001） and no statistical difference between 2w, lm, 6m and ly（P〉0.05）. 25 cases （24.5%） which including 14 cases of deficient correction and 11 cases of excessive cor- rection were adjusted. Conclusions Adjustable suture of rectus muscle combined rectus liner tucking is easy and ef- fective procedure for treatment of congenital esotropia. This method enable to significant decrease of the need for repetitive surgery and increase rate of orthophoria prophase post-surgery.

关 键 词：直肌 调整缝线术 折叠术 婴幼儿 先天性内斜视 

分 类 号：R779.6[医药卫生—眼科]