单侧与双侧内直肌后徙术治疗儿童集合过强型内斜视的疗效比较
发布时间：2018-08-09 20:06
【摘要】：研究背景和目的：集合过强型内斜视的临床表现为戴镜看近的斜视度比戴镜看远的斜视度≥10PD。集合过强型内斜视经梯度法检测后可被分为以下3种类型：(1)屈光性调节性内斜视伴有高AC/A；(2)非屈光性调节性内斜视伴有高AC/A；(3)非调节性集合过强型内斜视。其中伴有高AC/A的屈光性调节性内斜视比较常见,后2种类型临床相对少见。对于伴有高AC/A的集合过强型内斜视,临床上常采用戴双焦点眼镜治疗,但患儿看远也存在斜视或戴双焦点眼镜看近仍有明显内斜视时,则需手术治疗。而非调节性集合过强型内斜视的唯一治疗方法为斜视矫正术。双侧内直肌后徙术因操作相对简单,疗效确切、术后并发症少被公认为治疗集合过强型内斜视的常用术式。近年来有文献报道采用单侧内直肌后徙术亦可有效的矫正中小度数的集合过强型内斜视。本文旨在比较单侧内直肌后徙与双侧内直肌后徙术治疗儿童集合过强型内斜视的疗效。 方法：回顾性系列病例研究。收集2009年7月至2013年3月在山东大学附属省立医院行单侧内直肌后徙与双侧内直肌后徙术治疗、并符合纳入标准的集合过强型内斜视患儿共66例,均按照戴镜看近斜视度设计手术量,行单侧内直肌后徙29例、双侧内直肌后徙37例。疗效评价标准为看远和看近斜视度(0~+9)PD为正位。采用x2检验对两组手术后正位率、欠矫率及过矫率进行统计比较；采用配对t检验比较手术前后看近与看远斜视度差值(N-D)的差异,采用独立样本t检验比较两组术后看近斜视度、看远斜视度、N-D及手术前后N-D变化值的差异。 结果：术后远期(11.62±8.21月)随访,两组正位率、欠矫率及过矫率的差异均无统计学意义(P0.05)；两组看近斜视度(P=0.253)、看远斜视度(P=0.140)的差异均无统计学意义；单侧内直肌后徙组的N-D术前为(15.21±4.29)PD,术后为(3.93±5.61)PD,手术前后N-D的差异有统计学意义(P=0.000)；双侧内直肌后徙组的N-D术前为(15.37±4.69)PD,术后为(3.84±4.77)PD,手术前后N-D的差异有统计学意义(P=0.000)。两组术后N-D的差异无统计学意义(P=0.322)；手术前后N-D的变化值单侧内直肌后徙组为(11.28±7.00)PD,双侧内直肌后徙组为(11.54±5.82)PD,两组差异无统计学意义(P=0.249)。术后正位的44例患儿中,30例患儿能配合双眼单视功能检查,其中22例(73.3%)获得了周边融合(4例同时获得了中心融合)；16例(53.3%)获得了不同程度的近立体视觉(3000-400"),4例获得了精细立体视觉(40”)。 结论：按照戴镜看近斜视度设计手术,单侧内直肌后徙术治疗儿童中、小度数集合过强型内斜视与双侧内直肌后徙术治疗儿童中、大度数集合过强型内斜视的疗效相同,两种术式均能有效的减小看近与看远斜视度的差值。
[Abstract]:Background and objective: the clinical manifestation of overstrong esotropia is that the degree of strabismus is greater than 10 PD. There are three types of intensive esotropia: (1) accommodative esotropia with high AC / A; (2) non-refraction accommodative esotropia with high AC / A; (3) unadjustable set with overstrong esotropia. Refractive accommodative esotropia with high AC/A is common, and the latter two types are relatively rare. For the patients with high AC/A, the patients with intensive esotropia are often treated with binocentric glasses, but there is strabismus or esotropia with binocentric glasses. The only treatment for non-accommodative intensive esotropia is strabismus correction. Bilateral medial rectus recession is relatively simple and effective, and postoperative complications are rarely recognized as common methods for the treatment of intensive esotropia. In recent years, it has been reported that unilateral medial rectus recession can also be used to correct the over-intensive esotropia. The purpose of this study was to compare the efficacy of unilateral medial rectus recession and bilateral medial rectus recession in the treatment of intensive esotropia in children. Methods: a series of retrospective case studies. From July 2009 to March 2013, 66 patients with unilateral rectus and bilateral rectus were treated in the provincial hospital affiliated to Shandong University. All patients were treated with unilateral medial rectus and bilateral medial rectus in 29 cases and bilateral rectus muscle in 37 cases. The criteria for evaluation of curative effect were (0 ~ 9) PD and (0 ~ 9) PD were positive. The positive position rate, undercorrection rate and overcorrection rate after operation were statistically compared between the two groups by using x2 test, and the difference between near and far strabismus (N-D) before and after operation was compared by paired t test. The difference of the degree of near strabismus, the degree of far strabismus and the changes of N-D before and after operation were compared between the two groups by independent t-test. Results: there was no significant difference in the positive position rate, undercorrection rate and overcorrection rate between the two groups (P 0.05), but there was no significant difference between the two groups in the near strabismus (P < 0. 253) and the distance strabismus (P < 0. 140), in the long term postoperative follow-up (11. 62 卤8. 21 months), there was no significant difference between the two groups in the positive position rate, the undercorrection rate and the overcorrection rate (P 0. 05). The N-D of unilateral rectus group was (15.21 卤4.29) PDbefore and (3.93 卤5.61) PD. the difference of N-D before and after operation was statistically significant (P0. 000), the N-D of bilateral medial rectus recession group was (15. 37 卤4. 69) PDbefore operation and (3. 84 卤4. 77) PD. the difference before and after operation was statistically significant (P0. 000). There was no significant difference in N-D between the two groups before and after operation (P < 0.322), but the change of N-D in unilateral rectus group was (11.28 卤7.00) PDand that in bilateral rectus group was (11.54 卤5.82) PD.There was no significant difference between the two groups (P < 0.249). 30 of 44 postoperatively orthostatic children were able to cooperate with binocular monocular function examination, of which 22 (73.3%) obtained peripheral fusion (4 cases obtained central fusion). 16 cases (53.3%) obtained different degrees of near stereo vision (3000-400 ") and 4 cases got fine stereo vision (40"). Conclusion: in the design of surgery according to the degree of proximal strabismus and unilateral rectus recession in the treatment of children, in the treatment of children with small degrees of overstrong esotropia and bilateral rectus, the curative effect of large degree collection of excessive esotropia is the same as that of bilateral internal rectus recession. Both methods can effectively reduce the difference between near and far strabismus.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R777.41
本文编号：2175171
[Abstract]:Background and objective: the clinical manifestation of overstrong esotropia is that the degree of strabismus is greater than 10 PD. There are three types of intensive esotropia: (1) accommodative esotropia with high AC / A; (2) non-refraction accommodative esotropia with high AC / A; (3) unadjustable set with overstrong esotropia. Refractive accommodative esotropia with high AC/A is common, and the latter two types are relatively rare. For the patients with high AC/A, the patients with intensive esotropia are often treated with binocentric glasses, but there is strabismus or esotropia with binocentric glasses. The only treatment for non-accommodative intensive esotropia is strabismus correction. Bilateral medial rectus recession is relatively simple and effective, and postoperative complications are rarely recognized as common methods for the treatment of intensive esotropia. In recent years, it has been reported that unilateral medial rectus recession can also be used to correct the over-intensive esotropia. The purpose of this study was to compare the efficacy of unilateral medial rectus recession and bilateral medial rectus recession in the treatment of intensive esotropia in children. Methods: a series of retrospective case studies. From July 2009 to March 2013, 66 patients with unilateral rectus and bilateral rectus were treated in the provincial hospital affiliated to Shandong University. All patients were treated with unilateral medial rectus and bilateral medial rectus in 29 cases and bilateral rectus muscle in 37 cases. The criteria for evaluation of curative effect were (0 ~ 9) PD and (0 ~ 9) PD were positive. The positive position rate, undercorrection rate and overcorrection rate after operation were statistically compared between the two groups by using x2 test, and the difference between near and far strabismus (N-D) before and after operation was compared by paired t test. The difference of the degree of near strabismus, the degree of far strabismus and the changes of N-D before and after operation were compared between the two groups by independent t-test. Results: there was no significant difference in the positive position rate, undercorrection rate and overcorrection rate between the two groups (P 0.05), but there was no significant difference between the two groups in the near strabismus (P < 0. 253) and the distance strabismus (P < 0. 140), in the long term postoperative follow-up (11. 62 卤8. 21 months), there was no significant difference between the two groups in the positive position rate, the undercorrection rate and the overcorrection rate (P 0. 05). The N-D of unilateral rectus group was (15.21 卤4.29) PDbefore and (3.93 卤5.61) PD. the difference of N-D before and after operation was statistically significant (P0. 000), the N-D of bilateral medial rectus recession group was (15. 37 卤4. 69) PDbefore operation and (3. 84 卤4. 77) PD. the difference before and after operation was statistically significant (P0. 000). There was no significant difference in N-D between the two groups before and after operation (P < 0.322), but the change of N-D in unilateral rectus group was (11.28 卤7.00) PDand that in bilateral rectus group was (11.54 卤5.82) PD.There was no significant difference between the two groups (P < 0.249). 30 of 44 postoperatively orthostatic children were able to cooperate with binocular monocular function examination, of which 22 (73.3%) obtained peripheral fusion (4 cases obtained central fusion). 16 cases (53.3%) obtained different degrees of near stereo vision (3000-400 ") and 4 cases got fine stereo vision (40"). Conclusion: in the design of surgery according to the degree of proximal strabismus and unilateral rectus recession in the treatment of children, in the treatment of children with small degrees of overstrong esotropia and bilateral rectus, the curative effect of large degree collection of excessive esotropia is the same as that of bilateral internal rectus recession. Both methods can effectively reduce the difference between near and far strabismus.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R777.41
【参考文献】
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1 赵堪兴;斜视矫正术设计的思考[J];中华眼科杂志;2002年08期
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