合并下斜肌亢进的外斜Ⅴ征的个性化手术治疗的长期疗效观察  

Long-term efficacy of individualized surgical treatment for exotropia V syndrome with inferior oblique hypertrophy

作　　者：杜玲芳[1] 谭华霞[1] 张艳丽[1] 何芳[1] 宋伟琼[1] 高娜[1] Du Lingfang;Tan Huaxia;Zhang Yanli;He Fang;SongWeiqiong;Gao Na(Ophthalmology Center,Chenzhou First People's Hospital of Hunan Province,Chenzhou,Hunan,423000,China)

机构地区：[1]湖南省郴州市第一人民医院眼视光中心,湖南郴州423000

出　　处：《当代医学》2020年第29期55-57,共3页Contemporary Medicine

摘　　要：目的探讨伴有下斜肌亢进的Ⅴ型外斜视的手术治疗方法和长期疗效。方法选取2015年6月至2017年9月本院收治的61例合并下斜肌亢进的外斜Ⅴ征患者,根据其双眼下斜肌亢进是否对称,分为3组。A组19例单侧下斜肌亢进的患者,手术采用单眼下斜肌切断术治疗Ⅴ征;B组18例双侧下斜肌亢进且双侧下斜肌亢进相差(0^+1)的患者,手术采用双眼下斜肌切断术治疗Ⅴ征;C组24例双侧下斜肌亢进且双侧下斜肌亢进相差(+2^+3)的患者,手术采用一眼下斜肌单纯切断加另一眼下斜肌部分肌肉切除术治疗Ⅴ征。观察3组患者术后1年的眼位、斜肌功能和双眼视觉的情况。结果手术后1年复查:A组18例第一眼位没有外斜视,1例外斜视欠矫,2例出现对侧下斜肌亢进,17例上下转25°Ⅴ征消失,双眼下斜肌无亢进,10例同视机检查具有二级功能;B组15例第一眼位没有外斜视,2例外斜视过矫,1例外斜视欠矫,17例上下转25°Ⅴ征消失,5例同视机检查具有二级功能;C组22例上下转25°Ⅴ征消失,2例残余单眼下斜肌亢进(+1^+2),21例第一眼位没有外斜视,1例外斜视过矫,2例外斜视欠矫,3例同视机检查具有二级功能。结论外斜Ⅴ征根据是否伴有双侧下斜肌功能亢进及双侧亢进程度制定手术方案,而采取个性化手术治疗的长期疗效确切,手术矫正有利于部分患者获得双眼单视功能。Objective To explore the method and long-term effect of individualized surgical treatment for V-exotropia with inferior oblique hypertrophy.Methods A total of 61 patients with external oblique V sign with hypertrophic inferior oblique muscle who were admitted to our hospital from June 2015 to September 2017 were selected and they were divided into three groups according to whether their inferior oblique hypertrophy was symmetrical or not.In group A,19 cases of unilateral inferior oblique hypertrophy were treated by unilateral inferior oblique myotomy.In group B,18 cases of bilateral inferior oblique hypertrophy with difference between bilateral inferior oblique hypertrophy(0^+1)were treated by bilateral inferior oblique myotomy.In group C,24 cases of bilateral inferior oblique hypertrophy with difference between bilateral inferior oblique hypertrophy(+2^+3).One eye of inferior oblique muscle was simply amputated and the other eye of inferior oblique muscle was partially resected to treat V sign.Eye position,oblique muscle function and binocular vision were observed in three groups one year after operation.Results One year follow-up after operation:18 cases in group A had no exotropia in the first eye position,1 case had undercorrection of strabismus,2 cases had contralateral inferior oblique hypertrophy,17 cases up and down 25°V signs disappeared and there was no hypertrophy of the inferior oblique muscles of both eyes,and 10 cases had secondary function by synoptophore examination.In group B,15 cases had no exotropia in the first eye position,2 cases had hypercorrection of exotropia,1 case had undercorrection of exotropia,17 cases up and down 25°V signs disappeared,and 5 cases had secondary function by synoptophore examination.In group C,there were 17 cases up and down 25°V signs disappeared,2 cases of residual monocular inferior oblique hypertrophy(+1^+2),21 cases with no exotropia in the first eye position,1 case with exotropia overcorrection,2 cases with exotropia undercorrection,and 3 cases with secondary

关 键 词：外斜Ⅴ征 下斜肌亢进 双眼视力 

分 类 号：R779.6[医药卫生—眼科]