上直肌移位及其联合加强缝线术与垂直肌移位术治疗完全性展神经麻痹性斜视的临床效果观察  

Clinical observation of superior rectus transposition with/without augmented suture and vertical rectus transposition for the treatment of strabismus caused by complete abducens nerve palsy

作　　者：刘育榕 李月平[1] 张伟 杨士强[1] 丁娟[1] Liu Yurong;Li Yueping;Zhang Wei;Yang Shiqiang;Ding Juan(Tianjin Eye Hospital,Nankai University Affiliated Eye Hospital,Clinical College of Ophthalmology of Tianjin Medical University,Tianjin Eye Institute,Tianjin Key Laboratory of Ophthalmology and Vision Science,Tianjin 300020,China;Department of Ophthalmology,Dalian No.3 People's Hospital,Dalian 116033,China)

机构地区：[1]天津市眼科医院,南开大学附属眼科医院,天津医科大学眼科临床学院,天津市眼科研究所,天津市眼科学与视觉科学重点实验室,天津300020 [2]大连市第三人民医院眼科,大连116033

出　　处：《中华眼科杂志》2022年第9期693-700,共8页Chinese Journal of Ophthalmology

基　　金：天津市自然科学基金(21JCYBJC01860);天津市卫生健康委员会科技项目(ZC20187);天津市医学重点学科(专科)建设项目;天津市眼科医院科技基金资助面上项目(YKZD2001)。

摘　　要：目的比较上直肌移位术(SRT)、上直肌移位术联合加强缝线术(SRTA)与垂直肌移位术(VRT)治疗完全性展神经麻痹性斜视的疗效和安全性。方法回顾性队列研究。收集2015年1月至2020年11月在天津市眼科医院行斜视矫正手术的完全性展神经麻痹性斜视42例(42只眼)患者资料。根据术式分为:SRT组(16例),即SRT联合内直肌后徙术(MRc);SRTA组(13例),即SRT联合Buckley缝线和MRc;VRT组(13例)。分析比较3个组术前及术后1、6、12个月的斜视度数、眼球运动、双眼视功能及术后并发症等情况。计数资料组间比较采用χ^(2)检验;计量资料采用重复测量方差分析,组间及组内两两比较采用LSD-t检验。结果3个组间性别分布、年龄及病程差异均无统计学意义(均P>0.05)。3个组术后1、6、12个月的斜视度数均低于术前,差异均有统计学意义(均P<0.001),其中SRT组、SRTA组、VRT组术后12个月斜视度数分别为(+0.8±5.8)、(+0.8±4.5)、(+1.2±2.5)三棱镜度(PD),均低于术前的(+82.8±17.2)、(+77.7±26.1)、(+71.5±18.6)PD;但术后各时间点间差异均无统计学意义(均P>0.05)。术前及术后3个组之间斜视度数差异无统计学意义(P>0.05)。3个组术后1、6、12个月的麻痹眼外转功能分级与术前比较差异均有统计学意义(均P<0.001),如SRT组、SRTA组、VRT组术前外转功能分级分别为(-4.4±0.5)、(-4.4±0.5)、(-4.5±0.5)级,术后12个月分别为(-2.3±0.7)、(-2.2±0.5)、(-2.1±0.6)级;但术后各时间点间差异均无统计学意义(均P>0.05)。术前及术后3个组之间麻痹眼外转功能差异无统计学意义(P>0.05)。3个组术后1、6、12个月麻痹眼内转功能分级与术前比较差异均有统计学意义(均P<0.05),术后各时间点之间差异均无统计学意义(均P>0.05)。术后6、12个月麻痹眼内转功能分级,SRT组[(-0.9±0.6)、(-0.8±0.6)级]与SRTA组[(-1.5±0.5)、(-1.4±0.5)级](t=-2.62、-2.52)、SRTA组与VRT组[(-0.8±0.8)、(-0.6±0.7)级Objective To evaluate the efficacy and safety of superior rectus transposition(SRT)with/without augmented suture and vertical rectus transposition(VRT)for the treatment of strabismus caused by complete abducens nerve palsy.Methods This was a retrospective cohort study.Forty-two patients(42 eyes)with complete abducens nerve palsy underwent strabismic surgeries from January 2015 to November 2020 in Tianjin Eye Hospital.According to the different procedures,the patients were divided into three groups:SRT group(16 cases,SRT with medial rectus recession),superior rectus transposition with augmented suture(SRTA)group(13 cases,SRT with Buckley suture and medial rectus recession)and VRT group(13 cases).The preoperative and postoperative(1,6 and 12 months)data including deviations,ocular motility,binocular vision and surgical complications among three groups were analyzed and compared.χ^(2) test was used for comparison of count data among three groups.The measurement data were compared among three groups by the repeated measures ANOVA.LSD-t test was used for within-group comparison and between-group comparison.Results There was no difference in sex ratio,age and course of disease among the groups(all P>0.05).The horizontal deviations of the three groups at 1,6 and 12 months after surgeries was lower than that before surgeries,and the difference was statistically significant(all P<0.001).The horizontal deviations of the SRT group,SRTA group and VRT group at 12 months after surgeries were(+0.8±5.8),(+0.8±4.5),(+1.2±2.5)prism diopters(PD),respectively,lower than that of the preoperative(+82.8±17.2),(+77.7±26.1),(+71.5±18.6)PD.However,there was no significant difference among different postoperative follow-up timepoints(all P>0.05).There was no difference in horizontal deviations before surgeries and at 1,6 and 12 months after surgeries among three groups(P>0.05).There were significant differences in the scales of abduction motility among preoperative,postoperative 1,6 and 12 months measurements for three group(all P<0

关 键 词：眼球运动 眼外科手术 上直肌移位术 垂直肌移位术 展神经麻痹 斜视 

分 类 号：R779.6[医药卫生—眼科]