直肌联接术与眶骨膜固定术的比较研究  

Comparative Study of Rectus Muscle Union and Orbital Periosteum Fixation

作　　者：张扬[1] 陈绍春[2] 唐敏 孙涛[4] 

机构地区：[1]昆明医科大学第一附属医院眼科,云南昆明650032 [2]昆明医科大学解剖学教研室,云南昆明650500 [3]官渡区妇幼保健中心眼科,云南昆明650200 [4]昆明医科大学第一附属医院神经外科,云南昆明650032

出　　处：《昆明医科大学学报》2014年第4期65-69,共5页Journal of Kunming Medical University

基　　金：云南省自然科学基金资助项目(2010ZC110);云南省科技厅-昆明医科大学联合专项基金资助项目(2012FB037)

摘　　要：目的对比分析直肌联接术与眶骨膜固定术对麻痹性内斜视和固定性内斜视的治疗效果.方法回顾性分析了昆明医科大学第一附属医院眼科2002年2月至2013年4月收治的麻痹性内斜视50人,固定性内斜视22人.根据手术方法的不同2种内斜视各分为A组(直肌联接术)和B组(眶骨膜固定术).分析2种手术的方法及特点,分别定性比较二组治疗前、后复视改变及眼球运动,定量比较斜视度变化;并对每种内斜视2组之间相关性进行比较.结果 (1)2种内斜视A、B组术后1周,前方复视消失;术后2月,A组部分患者前方复视出现,而B组的没有变化;(2)术后1周及2月复诊,麻痹性内斜视A组眼球可向颞侧转动8°左右,其余方向运动无受限;B组眼球只能轻微上下转动,其余方向运动受限.固定性内斜视A组部分眼球可轻微内转或上下转,不能外转.B组不能运动;(3)2种内斜视术后1周A、B组斜视度检查正位至-5°(0^-10△)(P<0.05),术后2月与术后1周比较A组斜视度回退欠矫(P<0.05),B组未回退(P>0.05);(4)术前及术后1周,2种内斜视A、B组之间斜视度比较无统计学差异(P>0.05);术后2月斜视度比较有统计学差异(P<0.05).结论 (1)2种手术对麻痹性和固定性内斜视的斜视度矫正近期效果满意,但远期联接术较固定术易复发;(2)联接术不影响眼球转动,甚至可以恢复部分运动,而固定术对眼球运动有明显的限制作用;(3)联接术后复发,程度较重的麻痹性内斜视可以采用眶骨膜固定术,程度较轻的固定性内斜视可以采用直肌联接术.Objective To comparatively analyze the effect of Rectus muscle union （RMU） and orbital periosteum fixation （OPF） on paralytic esotropia and esotropia fixus. Methods 50 cases of paralytic esotropia and 22 cases of esotropia fixus were analyzed retrospectively in the department of ophthalmology, the First Affiliated Hospital of Kunming Medical University from February 2002 to April 2013 . According to the different surgical methods, two kinds of esotropia were divided into group A （RMU） and group B （OPF） . After analyzed procedure and characteristics of two kinds of surgery, the changes of diplopia and eyeball movement were comparedqualitatively, as well as the degree of strabismus angle done quantitatively in two groups respectively before and after the treatment. Finally, the correlation of each esotropia was compared between two groups. Results （1） The abduct about 8 ° to the temporal side in Group A of PE, and the other directions was seldom restricted; While eyeball in Group B can turn upward and downward slightly , but the other direction movement was limited 1 weeks and 2 months after surgery. A few cases of eyeball can turn to nasal side or up and downwords slightly in group A of EF. However, all directions was limited in group B ; 3, The mean strabismus angle of both groups was within ± 5 ° （0 ± 10） in Each esotropia after 1 weeks of surgery （P〈0.05） ;The strabismus angle in group A regressed after 2 months of surgery compared with that of 1 week late （P〈O.05） while group B did not change （P〉O.05） 4. Strabismus angle of each esotropia was no statistical difference in both groups before and after 1 weeks of surgery （P〉0.05） ; However, the strabismus angle was more different in both groups after 2 months later （P〈O.05） Conclusion （1） The results of two surgeries for PE and EF correcting strabismus are satisfactory. However, esotropia treated by RMU is more recurrent than OPF in the long term. （2） The RMU does not only affect the eye movement,

关 键 词：直肌联接术 眶骨膜固定术 麻痹性内斜视 固定性内斜视 比较 

分 类 号：R777.41[医药卫生—眼科]