下斜肌前转位在歪头大角度垂直偏斜中的应用  

Inferior oblique anterior transposition in treatment of large vertical deviation in head tilt

作　　者：刘雯[1] 黄丽娟[2] 王媛[1] 李莉[1] 李宁东[1] Liu Wen;Huang Li-juan;Wang Yuan(Department of Ophthalmology,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China;不详)

机构地区：[1]国家儿童医学中心首都医科大学附属北京儿童医院眼科,100045 [2]福建医科大学附属第二医院眼科

出　　处：《中国斜视与小儿眼科杂志》2023年第3期1-4,共4页Chinese Journal of Strabismus & Pediatric Ophthalmology

摘　　要：目的探索下斜肌前转位术在解决Bielschowsky歪头试验时发生大角度垂直偏斜的临床应用。方法回顾性分析2019年6月至2022年8月存在歪头试验大角度垂直偏斜的先天性SOP患儿的临床资料,进行下斜肌前转位术,观察术前术后代偿头位、原在位斜视度、眼底外旋、歪头试验垂直斜视度、下睑缘角膜映光距离(MRD2)变化情况。结果原在位垂直斜视度术前平均6.56^(Δ)±0.53^(Δ),术后平均2.11^(Δ)±0.61^(Δ),差异有显著性(P=0.000);术前患眼外旋平均12.52°±1.81°,术后平均6.64°±0.81°,差异有显著性(P=0.001);全部患者头位得到明显改善,其中72.2%的患者头位消失;术后下斜肌亢进均消失;头向患侧倾斜后术前垂直斜视度平均33.67^(Δ)±3.49^(Δ),术后平均6.22^(Δ)±0.79^(Δ),差异有显著性(P=0.000),头向患侧倾斜后,平均MRD2术前患眼6.89±0.27mm,术后患眼5.00±0.19mm,术前术后健眼均为4.67±0.17mm,术前患眼、健眼比较(P=0.000)和患眼术前术后比较(P=0.000),而术后MRD2患眼、健眼比较差异无统计学意义(P=0.218)。结论下斜肌前转位适合于歪头试验时发生更大垂直偏斜的先天性SOP患者,能够在改善头位、减少原在位斜视度和患眼外旋的同时,有效地减少向患侧歪头时发生的大角度垂直偏斜。Objective To investigate the effectiveness of inferior oblique(10)anterior transposition in large vertical deviation in the Bielschowsky head tilt test(BHTT).Methods Medical recorded were retrospectively reviewed for those patients with congenital SOP who had an increased large deviation angle in BHTT and underwent anterior transposition of IO.Surgical outcomes were evaluated by comparing the status of head tilt,the vertical deviations in the cardinal diagnostic positions,fundus torsion,and Marginal reflex distance-2(MRD2)before and after surgery.Results The average vertical strabismus in original position was 6.56±0.53PD versus 2.11±0.61PD before and after surgery with significant difference(P=0.000).The mean external rotation of the eyes was 12.52°±1.81°versus 6.64°±0.81°before and after surgery,and the difference was statistically significant(P=0.001).The head position of all patients was significantly improved,of which 72.2%was disappeared.The IO overaction of all the patients disappeared after surgery.After head tilt to the affected side,the mean vertical squint was significantly decreased from 33.67±3.49PD to 6.22±0.79PD(P=0.000)and the mean MRD2 of affected eyes was minished from 6.89±0.27mm to 5.00±0.19mm after surgery.The MRD2 of the contralateral eyes before and after surgery was 4.67±0.17mm.To compare the differences in MRD2,the affected eye and the contralateral eye was significantly different before surgery(P=0.000).Meanwhile,the difference of affected eye preand post-operation was also significant(P=0.000).However,the difference between the affected eye and the contralateral eye after surgery was not significant(P=0.218).Conclusion The anterior transposition of IO is suitable for the patients of congenital SOP with large angle BHTT.It could improve the head position,reduce the primary position of vertical deviation and the affected eye outward rotation,and effectively reduce the large angle vertical deviation during the head tilt to the affected side.

关 键 词：上斜肌麻痹 下斜肌前转位 歪头试验 垂直偏斜 

分 类 号：R779.6[医药卫生—眼科]