儿童基本型间歇性外斜视不同手术方式的疗效比较

发布时间：2018-07-18 07:54

【摘要】：目的比较双眼外直肌后徙术与单眼一退一截术治疗儿童基本型间歇性外斜视的疗效。方法研究对象为2011年8月至2014年10月在南京医科大学附属南京儿童医院眼科被确诊为基本型间歇性外斜视并行手术治疗的患儿93例137眼,行双眼外直肌后徙术(bilateral lateral rectus recession,BLR-rec)44例88眼,行单眼一退一截术(unilateral recess-resection,RR)术49例49眼。采用三棱镜加交替遮盖法测量患儿经1 h诊断性遮盖前后注视6 m及33 cm调节性视标第一眼位的斜视度。检查患儿近立体视锐度。依据诊断性遮盖后测量的最大看远斜视度及双眼注视偏爱,行BLR-rec或RR,所有手术均由同一医师完成。术后1 d、1个月、6个月检查患儿的斜视度和近立体视功能。结果术后1~3 d及术后1个月,RR组的整体疗效均优于BLR-rec组(χ2=6.324,P=0.042;χ2=6.747,P=0.034)。BLR-rec组欠矫率在术后1~3 d及术后1个月均高于RR组(χ2=5.959,P=0.015;χ2=6.461,P=0.011),正位率及过矫率的差异无统计学意义(均为P0.05);术后远期两组疗效差异无统计学意义(均为P0.05)。术后两组看远及看近斜视度的差异在各时间点均无统计学意义(均为P0.05)。术后两组获得正常近立体视功能的患儿比例比较,差异无统计学意义(χ2=0.075,P=0.784)。结论治疗儿童基本型间歇性外斜视应首选RR。
[Abstract]:Objective to compare the effects of bilateral rectus recession and monocular retraction in the treatment of basic intermittent exotropia in children. Methods from August 2011 to October 2014, 93 patients (137 eyes) with primary intermittent exotropia were diagnosed as primary intermittent exotropia in Nanjing Children's Hospital affiliated to Nanjing Medical University, and 88 eyes of 44 cases (88 eyes) were treated with bilateral rectus recession (bilateral lateral rectus recessionaire BLR-rec). 49 cases (49 eyes) were treated with unilateral recess-resectional RR. The strabismus of 6 m and 33 cm regulatory visual marker was measured by the method of prism and alternating shading before and after 1 hour of diagnostic covering. The near stereoscopic acuity of the children was examined. BLR-rec or RRR were performed on the basis of the maximum distance strabismus and binocular fixation preference measured after the diagnostic covering. All the operations were performed by the same physician. Strabismus and near stereopsis were examined 1 day, 1 month and 6 months after operation. Results the overall curative effect of the RR group was better than that of the BLR-rec group on the 3rd day and the first month after operation (蠂 ~ 2 ~ 2 ~ (6.324) P ~ (0.042); 蠂 ~ (2 +) ~ (6.747) P ~ (0.034). The undercorrection rate in the BLR-rec group was significantly higher than that in the RR group on the 3rd day and 1 month after operation (蠂 ~ (25.959) P ~ (0.015); 蠂 ~ (2) 6.461g / P ~ (0.011). There was no significant difference in the positive position rate and overcorrection rate between the two groups (P 0.05). There was no significant difference in curative effect between the two groups (P0.05). There was no significant difference between the two groups at all time points (P0.05). There was no significant difference in the proportion of children with normal near stereopsis between the two groups after operation (蠂 ~ 2 / 0. 075 / P ~ (0.784). Conclusion RR should be the first choice in the treatment of children with basic intermittent exotropia.
【作者单位】：南京医科大学附属南京儿童医院;
【分类号】：R779.6

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