下斜肌后固定术在外斜V征中的应用  

Application of the Inferior Oblique Muscle Belly Transposition in V-Pattern Exotropia

作　　者：司明宇 邵新香 范可顺 Mingyu Si;Xinxiang Shao;Keshun Fan(Department of Ophthalmology of Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University,Xuzhou No.1 People's Hospital,the Affiliated Hospital of China University of Mining and Technology,Xuzhou 221001,China)

机构地区：[1]徐州市第一人民医院,徐州医科大学附属徐州市立医院,中国矿业大学附属医院眼科,221001

出　　处：《中华眼视光学与视觉科学杂志》2021年第2期120-127,共8页Chinese Journal Of Optometry Ophthalmology And Visual Science

基　　金：徐州市科技计划项目(KC19166)。

摘　　要：目的:探讨下斜肌后固定术(IOBT)在伴有轻中度下斜肌功能亢进的V型斜视中的治疗效果。方法:前瞻性研究。选择2018年1月至2020年4月在徐州市第一人民医院行IOBT或者部分切除术的外斜V征患者40例,按照随机数字表法将患者随机分为IOBT组和下斜肌部分切除术(IOMYE)组,各20例。IOBT组行双眼IOBT+水平斜视矫正术,IOMYE组行双眼IOMYE+水平斜视矫正术。比较2组手术前后水平斜视度(HD)、V值、黄斑视乳头夹角(FDA)及下斜肌功能(IOA)等变化情况。随访时间为6个月。数据采用配对样本t检验、独立样本t检验进行分析。结果:IOBT组17例(85%)治愈,IOMYE组14例(70%)治愈。IOBT组手术前后FDA变化差异无统计学意义(t=1.313,P=0.205)。2组间手术前后FDA、IOA、V值变化值的差异均有统计学意义(t=-11.788,P<0.001;t=-3.701,P=0.001;t=-8.519,P<0.001)。IOBT组术后无一例过矫为A征。IOMYE组6例V征过矫为A征,IOA轻度不足8例。结论:IOBT术可安全、有效地治疗伴轻中度下斜肌亢进的外斜V征,是传统下斜肌减弱术的补充。Objective:To investigate the effect of the application of the inferior oblique muscle belly transposition(IOBT)in V-pattern strabismus with mild-to-moderate inferior oblique overaction(IOOA).Methods:This was a prospective study.From January 2018 to April 2020,40 patients(80 eyes)with V-pattern exotropia with minimal-to-moderate IOOA who underwent IOBT or inferior oblique myectomy(IOMYE)in Xuzhou No.1 People's Hospital were randomly divided into two groups:An IOBT group(n=20)and an IOMYE group(n=20).In addition to horizontal strabismus correction,the patients underwent IOBT in the IOBT group and inferior oblique myectomy(IOMYE)in the IOMYE group.There was a 6-month follow-up period.Horizontal deviation(HD),V pattern,foveal disc angle(FDA)and inferior oblique action(IOA)were analyzed before and after the operation.Data were analyzed using paired t test and independent t test.Results:Seventeen(85%)patients were cured in the IOBT group and 14(70%)in the IOMYE group.There was no significant difference(t=1.313,P=0.205)in FDA before and after surgery in the IOBT group.The differences in changes in FDA,IOA and V pattern between the two groups were statistically significant(t=-11.788,P<0.001;t=-3.701,P=0.001;t=-8.519,P<0.001).Postoperatively,the IOBT group achieved satisfactory results,without overcorrection to an A pattern.In the IOMYE group,6 patients were overcorrected to A pattern and 8 patients had mild underaction of the inferior oblique.Conclusions:IOBT can successfully treat the V pattern in patients with mild-to-moderate IOOA.It is a supplement to traditional inferior oblique muscle weakening.

关 键 词：下斜肌后固定术 V征 下斜肌功能亢进 下斜肌功能不足 

分 类 号：R779.6[医药卫生—眼科]