改良的单侧—退—截手术治疗儿童集合不足型间歇性外斜视的疗效观察
发布时间：2018-08-11 12:59
【摘要】：第一部分： 三种术式治疗儿童集合不足型间歇性外斜视的疗效比较 研究目的：比较单侧内直肌截除术、双侧内直肌截除术、改良的单侧外直肌后徙联合内直肌截除术(一退一截术)三种术式治疗儿童集合不足型间歇性外斜视的疗效。研究方法：前瞻性随机对照研究。本研究纳入45例集合不足型间歇性外斜视患儿,根据手术方式的不同,所有患儿被分为3组：单侧内直肌截除术组15例,双侧内直肌截除术组14例,改良的一退一截术组16例。采用三棱镜加交替遮盖试验进行斜视度测量,根据1小时诊断性遮盖后测量的最大斜视度手术。单侧内直肌截除术组和双侧内直肌截除术组均按照看远斜视度设计手术；改良的一退一截术组按照看远斜视度行外直肌后徙、按照看近斜视度行内直肌截除术。单侧内直肌截除术组和改良的一退一截术组均选择在患儿非注视眼上手术。术后随访时间为6个月。疗效成功的评价标准：第一眼位看远斜视度为+5～-10PD。 结果：最后随访时,改良的一退一截术组的手术成功率(87.5%)明显高于单侧内直肌截除术组(13.3%)和双侧内直肌截除术组(42.9%)(P=0.000,P=0.008)；三组术后平均看远和看近斜视度均较术前明显减少(单侧内直肌截除术组：P=0.004、P=0.000；双侧内直肌截除术组：P=0.003、P=0.000；改良的一退一截术组：P=0.000、P=0.000)；改良的一退一截术组术后看远和看近斜视度较术前减少的度数优于单侧内直肌截除术组(P=0.000)和双侧内直肌截除术组(P=0.001)。而单侧内直肌截除术组与双侧内直肌截除术组两组之间看远和看近斜视度减少的程度差异无统计学意义(P=0.080、P=0.989)。三组术后看远与看近斜视度的差值均较术前明显减小(P=0.000)：单侧内直肌截除术组由术前11.3±2.1PD减少到术后1.5±7.6PD；双侧内直肌截除术组由术前12.3±2.5PD减少到术后5.0±5.2PD；改良的一退一截术组由术前11.9±2.8PD减少到术后1.9±2.7PD。改良的一退一截术组与单侧内直肌截除术组和双侧内直肌截除术组术后看远与看近斜视度差值的比较差异均无统计学意义(P0.05)。 结论：根据看远斜视度定量行外直肌后徙、根据看近斜视度定量行内直肌截除的改良的单侧一退一截术治疗儿童集合不足型间歇性外斜视的疗效优于根据看远斜视度定量行单侧内直肌截除术和双侧内直肌截除术。三种术式均可减小集合不足型间歇性外斜视患儿看远与看近斜视度的差值。 第二部分： 改良的单侧一退一截手术治疗儿童中小度数集合不足型间歇性外斜视的疗效观察 研究目的：评价按照看远斜视度行外直肌后徙、按照看近斜视度行内直肌截除(改良的一退一截术)治疗中小度数儿童集合不足型间歇性外斜视的疗效。 研究方法：对50例在山东大学附属山东省立医院眼科中心就诊的集合不足型间歇性外斜视儿童的连续性病例进行前瞻性为期1年的术后随访研究。所有患儿根据术前看远斜视度随机分成两组：A组19例,看远斜视度为15PD～25PD；B组31例,看远斜视度为30PD-40PD。疗效评价标准：看远斜视度在+5～-1OPD范围内为眼位正位。对A、B两组的手术成功率、看远和看近斜视度、看远与看近斜视度的差值进行比较。采用方差分析对两组术后看远、看近斜视度以及看远与看近斜视度的差值进行比较；采用卡方检验对两组手术正位率进行比较。以P值0.05为有统计学意义。 结果：术后12个月随访时,50例集合不足型间歇性外斜视儿童的手术成功率为74%；A组和B组的手术成功率分别为78.9%和71.0%。从术后早期到最后随访的各个时间点,A组与B组的手术成功率的差异均无统计学意义(P=0.537)。在术后12个月随访时,A组(17例)和B组(28例)的平均看远斜视度分别为-3.18±5.15PD和-5.96±6.43PD,平均看近斜视度分别为-6.76±8.86PD和-7.18±7.78PD；平均看远与看近斜视度的差值分别为3.82±5.1OPD和1.21±4.36PD。两组之间看远和看近斜视度及看远与看近斜视度差值的差异均无统计学意义(P=0.137,P=0.870,P=0.07)。结论：改良的单侧一退一截术对儿童中小度数集合不足型间歇性外斜视具有较好的疗效,并可减小看远与看近斜视度的差值。
[Abstract]:Part one:
Comparison of three surgical treatments for children with concomitant intermittent exotropia
Objective: To compare the efficacy of unilateral medial rectus myotomy, bilateral medial rectus myotomy, modified unilateral lateral lateral rectus recession combined with medial rectus myotomy (one retraction and one amputation) in the treatment of children with intermittent exotropia with insufficient collection. Strabismus children were divided into three groups according to different surgical methods: unilateral medial rectus myotomy group (15 cases), bilateral medial rectus myotomy group (14 cases) and modified one-step myotomy group (16 cases). Both the rectus myotomy group and the bilateral medial rectus myotomy group were designed according to the degree of hyperopia and strabismus; the modified one-step retraction group was performed according to the degree of hyperopia and strabismus, and the medial rectus myotomy was performed according to the degree of myopia. The follow-up period was 6 months. The criterion of success was +5-10 PD in the first eye.
Results: At the end of the follow-up, the success rate of the modified one-step myotomy group (87.5%) was significantly higher than that of the unilateral medial rectus myotomy group (13.3%) and the bilateral medial rectus myotomy group (42.9%) (P = 0.000, P = 0.008); the average postoperative distant and near strabismus of the three groups were significantly lower than those of the preoperative group (P = 0.004, P = 0.000). Lateral medial rectus myotomy group: P = 0.003, P = 0.000; modified one-step retraction and one-step myotomy group: P = 0.000, P = 0.000; modified one-step retraction and one-step myotomy group: postoperative distant and myopic strabismus were less than preoperative strabismus than unilateral medial rectus myotomy group (P = 0.000) and bilateral medial rectus myotomy group (P = 0.001). There was no significant difference between the two groups in the degree of reduction of distant and myopic strabismus (P = 0.080, P = 0.989). The difference of distant and myopic strabismus was significantly reduced in the three groups (P = 0.000). The unilateral medial rectus myotomy group was reduced from 11.3 [2.1PD] preoperatively to 1.5 [7.6PD] postoperatively, and the bilateral medial rectus myotomy group from 11.3 [2.1PD] preoperatively to 1.5 [7.6PD There was no significant difference in the difference of visual acuity and nearsightedness between the two groups (P 0.05).
CONCLUSION: The modified unilateral retraction and amputation of medial rectus according to the degree of hypertropia is superior to unilateral and bilateral myotomy of medial rectus according to the degree of hypertropia. The difference between the distant and near strabismus in children with concomitant intermittent exotropia.
The second part:
Observation on the effect of modified unilateral one-step retraction and one-step resection in the treatment of children with intermittent exotropia of mild and moderate aggregation insufficiency
Objective: To evaluate the effect of external rectus recession according to the degree of hypertropia and medial rectus amputation (modified one step retraction and one amputation) according to the degree of myopia on children with intermittent exotropia of small and medium degree of convergence.
Methods: A prospective 1-year follow-up study was conducted in 50 consecutive children with aggregated insufficient intermittent exotropia who were admitted to the Ophthalmological Center of Shandong Provincial Hospital Affiliated to Shandong University. The degree of hyperopia and strabismus was 30PD-40PD.The evaluation criteria of the curative effect were: the degree of hyperopia and strabismus was positioned in the range of +5-1 OPD. Chi-square test was used to compare the positioning rate of the two groups.
Results: At 12 months follow-up, the success rate of operation was 74% in 50 children with intermittent exotropia with insufficient collection, 78.9% in group A and 71.0% in group B. There was no significant difference in the success rate between group A and group B at all time points from early postoperative to final follow-up (P = 0.537). In group A (17 cases) and group B (28 cases), the average hyperopia and myopia were - 3.18 [5.15PD] and - 5.96 [6.43PD] respectively, and the average myopia was - 6.76 [8.86PD] and - 7.18 [7.78PD] respectively. The difference between the two groups was 3.82 [5.1OPD] and 1.21 [4.36PD] respectively. There was no significant difference between the two groups (P = 0.137, P = 0.870, P = 0.07). Conclusion: Modified unilateral retraction and one amputation is effective in treating children with intermittent exotropia of small and moderate aggregation insufficiency, and can reduce the difference between distant and nearsighted strabismus.
【学位授予单位】：山东大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R779.6
本文编号：2177064
[Abstract]:Part one:
Comparison of three surgical treatments for children with concomitant intermittent exotropia
Objective: To compare the efficacy of unilateral medial rectus myotomy, bilateral medial rectus myotomy, modified unilateral lateral lateral rectus recession combined with medial rectus myotomy (one retraction and one amputation) in the treatment of children with intermittent exotropia with insufficient collection. Strabismus children were divided into three groups according to different surgical methods: unilateral medial rectus myotomy group (15 cases), bilateral medial rectus myotomy group (14 cases) and modified one-step myotomy group (16 cases). Both the rectus myotomy group and the bilateral medial rectus myotomy group were designed according to the degree of hyperopia and strabismus; the modified one-step retraction group was performed according to the degree of hyperopia and strabismus, and the medial rectus myotomy was performed according to the degree of myopia. The follow-up period was 6 months. The criterion of success was +5-10 PD in the first eye.
Results: At the end of the follow-up, the success rate of the modified one-step myotomy group (87.5%) was significantly higher than that of the unilateral medial rectus myotomy group (13.3%) and the bilateral medial rectus myotomy group (42.9%) (P = 0.000, P = 0.008); the average postoperative distant and near strabismus of the three groups were significantly lower than those of the preoperative group (P = 0.004, P = 0.000). Lateral medial rectus myotomy group: P = 0.003, P = 0.000; modified one-step retraction and one-step myotomy group: P = 0.000, P = 0.000; modified one-step retraction and one-step myotomy group: postoperative distant and myopic strabismus were less than preoperative strabismus than unilateral medial rectus myotomy group (P = 0.000) and bilateral medial rectus myotomy group (P = 0.001). There was no significant difference between the two groups in the degree of reduction of distant and myopic strabismus (P = 0.080, P = 0.989). The difference of distant and myopic strabismus was significantly reduced in the three groups (P = 0.000). The unilateral medial rectus myotomy group was reduced from 11.3 [2.1PD] preoperatively to 1.5 [7.6PD] postoperatively, and the bilateral medial rectus myotomy group from 11.3 [2.1PD] preoperatively to 1.5 [7.6PD There was no significant difference in the difference of visual acuity and nearsightedness between the two groups (P 0.05).
CONCLUSION: The modified unilateral retraction and amputation of medial rectus according to the degree of hypertropia is superior to unilateral and bilateral myotomy of medial rectus according to the degree of hypertropia. The difference between the distant and near strabismus in children with concomitant intermittent exotropia.
The second part:
Observation on the effect of modified unilateral one-step retraction and one-step resection in the treatment of children with intermittent exotropia of mild and moderate aggregation insufficiency
Objective: To evaluate the effect of external rectus recession according to the degree of hypertropia and medial rectus amputation (modified one step retraction and one amputation) according to the degree of myopia on children with intermittent exotropia of small and medium degree of convergence.
Methods: A prospective 1-year follow-up study was conducted in 50 consecutive children with aggregated insufficient intermittent exotropia who were admitted to the Ophthalmological Center of Shandong Provincial Hospital Affiliated to Shandong University. The degree of hyperopia and strabismus was 30PD-40PD.The evaluation criteria of the curative effect were: the degree of hyperopia and strabismus was positioned in the range of +5-1 OPD. Chi-square test was used to compare the positioning rate of the two groups.
Results: At 12 months follow-up, the success rate of operation was 74% in 50 children with intermittent exotropia with insufficient collection, 78.9% in group A and 71.0% in group B. There was no significant difference in the success rate between group A and group B at all time points from early postoperative to final follow-up (P = 0.537). In group A (17 cases) and group B (28 cases), the average hyperopia and myopia were - 3.18 [5.15PD] and - 5.96 [6.43PD] respectively, and the average myopia was - 6.76 [8.86PD] and - 7.18 [7.78PD] respectively. The difference between the two groups was 3.82 [5.1OPD] and 1.21 [4.36PD] respectively. There was no significant difference between the two groups (P = 0.137, P = 0.870, P = 0.07). Conclusion: Modified unilateral retraction and one amputation is effective in treating children with intermittent exotropia of small and moderate aggregation insufficiency, and can reduce the difference between distant and nearsighted strabismus.
【学位授予单位】：山东大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R779.6
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