上直肌转位联合内直肌后徙术治疗外展神经麻痹性内斜视的临床疗效  

Clinical efficacy of superior rectus transposition combined with medial rectus recession in the treatment of sixth nerve paralytic esotropia

作　　者：许丽敏[1] 荣军博[1] 郎丽娟[1] 李志刚[1] XU Limin;RONG Junbo;LANG Lijuan;LI Zhigang(Department of Ophthalmology,the First Affiliated Hospital of Zhengzhou University,Henan Province Eye Hospital,Zhengzhou 450052,Henan Province,China)

机构地区：[1]郑州大学第一附属医院眼科,河南省眼科医院,河南省郑州市450000

出　　处：《眼科新进展》2021年第9期857-860,共4页Recent Advances in Ophthalmology

基　　金：国家卫生健康委科学研究基金-河南省医学科技攻关计划(联合共建)项目(编号SB201901013)。

摘　　要：目的探讨上直肌转位(SRT)联合内直肌后徙术(MRC)治疗外展神经麻痹性内斜视的临床疗效。方法回顾性系列病例研究。收集2017年9月至2020年3月郑州大学第一附属医院斜视与小儿眼科专业组收治的应用SRT联合MRC治疗的38例(50眼)外展神经麻痹性内斜视患者的临床资料。采用三棱镜角膜映光法测量所有患者第一眼位斜视度,第一眼位时应用角膜映光法评估眼球外转受限程度;Titmus立体图评估近立体视,同视机随机点图片评估远立体视。随访时间为6~14个月。采用配对样本t检验比较手术前后第一眼位的斜视度和外转受限程度,配对卡方检验比较手术前后立体视变化情况。结果38例(50眼)患者的第一眼位斜视度由术前的(75.53±13.17)PD降至术后6个月的(5.93±2.46)PD(t=12.49,P=0.00),外转受限程度由术前的-4.50±0.68改善至术后6个月的-1.87±0.55(t=-13.00,P=0.00)。术后20例患者近立体视恢复,17例患者远立体视恢复。2例患者术后仍残余小角度内斜视,配戴压贴三棱镜后复视消除。所有患者术后均未发生垂直斜视和旋转斜视。结论SRT联合MRC可有效矫正外展神经麻痹性内斜视,减少手术累及眼外肌的数目,且术后未发生明显垂直斜视和旋转斜视。Objective To investigate the clinical efficacy of superior rectus transposition(SRT)combined with medial rectus recession(MRC)in the treatment of sixth nerve paralytic esotropia.Methods It was a retrospective study involving 38 patients(50 eyes)with sixth nerve paralytic esotropia who were admitted in the Department of Strabismus and Pediatric Ophthalmology,the First Affiliated Hospital of Zhengzhou University from September 2017 to March 2020.The strabismus and the limitation of eyeball abduction at the primary position of eye were detected using the prism keratometry,and the Hirschberg test,respectively.Near and far stereoscopic visions were respectively assessed by near stereoscopic images and random-dot stereogram synoptophone.Patients were followed up for 6-14 months.The strabismus and the limitation of eyeball abduction at the primary position of eye before and after surgery were compared by the paired sample t test,and stereoscopic visions before and after surgery were compared by Chi-square test.Results The angle of deviation in the primary eye position in 38 patients with sixth nerve paralytic esotropia decreased from(75.53±13.17)PD preoperatively to(5.93±2.46)PD postoperatively(t=12.49,P=0.00).Besides,the limitation of eyeball abduction improved from-4.50±0.68 preoperatively to-1.87±0.55 postoperatively(t=-13.00,P=0.00).Near stereopsis was recovered postoperatively in 20 cases and far stereopsis was recovered in 17 cases.Two patients suffered residual small-angle horizontal strabismus,while the diplopia was eliminated after wearing press-on prism.New vertical and rotational strabismus was not observed in all cases.Conclusion SRT combined with MRC can effectively correct the sixth nerve paralytic esotropia,and reduce the number of involved extraocular muscles without obvious vertical and rotational strabismus.

关 键 词：内斜视 内直肌后徙术 上直肌转位术 外展神经麻痹 

分 类 号：R777.4[医药卫生—眼科]