联合术式矫正超大度数水平斜视的临床研究  

Clinical Study of Combined Operation for Correction of Extra-Large Angle Horizontal Strabismus

作　　者：张晓慧 李恒[1] 严丽英 王宁 刘全坤[1] 解宸 陶依凡 Zhang Xiaohui;Li Heng;Yan Liying(Ophthalmology Center of Suining Central Hospital,Suining,Sichuan 629000,China)

机构地区：[1]遂宁市中心医院眼科中心,四川遂宁629000 [2]遵义医科大学,贵州遵义563000 [3]成都中医药大学,四川成都610000

出　　处：《四川医学》2023年第2期169-173,共5页Sichuan Medical Journal

基　　金：遂宁市中心医院2021科研课题支撑计划(编号:2021y58);成都中医药大学2021年度“杏林学者”学科人才科研提升计划(编号:YYZX2021108)。

摘　　要：目的观察直肌侧切后退联合拮抗肌缩短及止端前移治疗超大度数水平斜视的临床效果。方法回顾性分析2008年8月至2019年7月在遂宁市中心医院眼科接受手术矫正、斜视度≥80^(△)的水平斜视患者102例,所有病例斜视度80^(△)~140^(△),平均(102.28±10.52)^(△)。按照眼位偏斜方向分为内斜视、外斜视两组;按不同斜视度分成3组:A组(≥80^(△)且<100^(△)),B组(≥100^(△)且<120^(△)),C组(≥120^(△)且<140^(△))。内斜视手术方式:双眼内直肌侧切+后退,同时联合一条或两条外直肌缩短+肌止端前移;外斜视手术方式:双眼外直肌侧切+后退,同时联合一条或两条内直肌缩短+肌止端前移。对其术中、术后并发症以及术后1周眼位进行观察和统计学分析。结果102例患者术中术后均无严重并发症发生。其中内斜视62例、术后正位58例、总正位率93.55%,其中A组正位27例,正位率96.43%,B组正位19例,正位率90.48%,C组正位12例,正位率90.31%。外斜视40例、术后正位33例、总正位率82.50%,其中A组正位17例,正位率89.47%,B组正位10例,正位率76.92%,C组正位6例,正位率75.00%。内斜视组与外斜视组、不同斜视度数组之间术后正位率差异均无统计学意义(P>0.05)。结论在显微镜下实施直肌侧切+后退联合拮抗肌缩短+肌止端前移治疗超大度数水平斜视,可以精准操作、减少术中术后发生并发症的风险,术后可以获得较好矫正效果。Objective To observe the clinical effect of lateral rectus muscle resection and retreat combined with antagonist muscle shortening and anterior stop in the treatment of hypertrophic horizontal strabismus.Methods Retrospective analysis was performed on 102 patients with horizontal strabismus who received surgical correction and the degree of strabismus≥80^(△)in the ophthalmology department of Suining Central Hospital from August 2008 to July 2019.All the patients had the degree of strabismus 80^(△)~140^(△),with an average of(102.28±10.52)^(△).According to the direction of eye deviation,they were divided into two groups:esotropia and exotropia.According to different oblique degrees,they were divided into three groups:Group A(≥80^(△)and<100^(△)),group B(≥100^(△)and<120^(△)),and group C(≥120^(△)and<140^(△)).The esotropia method indicated the lateral incision and retraction of the internal rectus muscle in both eyes,combined with shortening of one or both external rectus muscles and moving forward of the muscle stop.The exotropia method indicated the lateral incision and retraction of the external rectus muscle of both eyes,combined with shortening of one or both internal rectus muscles and anterior insertion of the muscle end.All surgeries were performed under an ophthalmic surgical microscope.The intraoperative and postoperative complications and postoperative eye position 1 week after operation were observed and statistically analyzed.Results No serious complications occurred in 102 patients during and after operation.Among them,62 cases were esotropia,58 cases were postoperatively orthotopic,and the total orthotopic rate was 93.55%,including 27 cases in group A(96.43%),19 cases in group B(90.48%),and 12 cases in group C(90.31%).There were 40 cases of exotropia,33 cases of postoperatively orthotopic,and the total orthotopic rate was 82.50%,including 17 cases in group A(89.47%),10 cases in group B(76.92%),and 6 cases in group C(75.00%).There was no statistical significance in postoperati

关 键 词：肌肉侧切 肌止端前移 超大度数 水平斜视 

分 类 号：R777.41[医药卫生—眼科]