共同性外斜视矫正手术联合下斜肌减弱术治疗儿童复杂斜视
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摘要
目的:观察共同性外斜视矫正手术联合下斜肌减弱术治疗儿童复杂斜视的临床疗效。方法:选取2015-01/2017-02我院收治的68例80眼复杂斜视患儿,均行共同性外斜视矫正手术,对其临床诊治进行回顾性分析,依据是否联合下斜肌减弱术治疗,分为联合组(30例35眼)与非联合组(38例45眼),比较两组患儿手术前后视功能、5m斜视度、下斜肌亢进程度、Titmus立体试验结果,并观察两组患者术后疗效。结果:术后6mo,两组具有同时视患者、一定融合范围患者、远立体视功能患者和近立体视正常者(40″~60″)所占比例均较术前明显升高(P<0. 05),但组间比较差异无统计学意义(P>0. 05)。术后6mo,两组患儿下斜肌亢进程度、5m斜视度与术前相比得到明显改善(P<0. 05),组间比较均无统计学差异(P> 0. 05);术后1~3d,1a随访显示,两组患儿正位率、过矫率和欠矫率比较差异均无统计学意义(P>0. 05)。结论:对儿童复杂斜视采取共同性外斜视矫正手术治疗时,联合下斜肌减弱术可能不会影响外斜视矫正效果,进行手术设计时,可忽略下斜肌减弱术对患儿水平斜视度产生的影响
AIM: To observe the clinical curative effect of surgical correction of concom itant exotropia com bined w ith w eakening procedures in the treatm ent of children w ith com plex strabism us.METHODS: Totally 68 children( 80 eyes) with complex strabismus who were admitted to the hospital from January 2015 to February 2017 were selected. All of them were treated by surgical correction of concomitant exotropia. The clinical diagnosis and treatment were retrospectively analyzed. They were divided into the combined group( n =30,35 eyes) and the non-combined group( n = 38,45 eyes) according to the implementation of inferior oblique weakening procedures. The visual function, 5 m exotropia deviation, degree of inferior oblique muscle overreaction and results of Titmus stereoscopic experiment were compared between the two groups before and after surgery. The postoperative curative effect of both groups was observed. RESULTS: The proportions of patients with simultaneous vision,patients with certain fusion range,patients with distant stereoscopic vision and normal patients with near stereoscopic vision( 40-60 s) in both groups were significantly increased surgery at 6 mo after surgery( P<0.05),without significant differences between groups( P>0.05). The degree of inferior oblique muscle overreaction and 5 m exotropia deviation in both groups were significantly improved at 6 mo after surgery( P <0. 05),but there was no significant difference between groups( P>0.05). Follow-up of 1-3 d,1 a after operation showed there were no significant differences between the two groups in the orthophoria rate,over-correction rate or under-correction rate( P>0. 05). CONCLUSION: In the treatment of children with complex strabismus by surgical correction of concomitant exotropia, the combined use of inferior oblique weakening procedures may not affect the correction effects of exotropia. When the surgery is designed,the impact of inferior oblique weakening procedures can be ignored.
AIM: To observe the clinical curative effect of surgical correction of concom itant exotropia com bined w ith w eakening procedures in the treatm ent of children w ith com plex strabism us.METHODS: Totally 68 children( 80 eyes) with complex strabismus who were admitted to the hospital from January 2015 to February 2017 were selected. All of them were treated by surgical correction of concomitant exotropia. The clinical diagnosis and treatment were retrospectively analyzed. They were divided into the combined group( n =30,35 eyes) and the non-combined group( n = 38,45 eyes) according to the implementation of inferior oblique weakening procedures. The visual function, 5 m exotropia deviation, degree of inferior oblique muscle overreaction and results of Titmus stereoscopic experiment were compared between the two groups before and after surgery. The postoperative curative effect of both groups was observed. RESULTS: The proportions of patients with simultaneous vision,patients with certain fusion range,patients with distant stereoscopic vision and normal patients with near stereoscopic vision( 40-60 s) in both groups were significantly increased surgery at 6 mo after surgery( P<0.05),without significant differences between groups( P>0.05). The degree of inferior oblique muscle overreaction and 5 m exotropia deviation in both groups were significantly improved at 6 mo after surgery( P <0. 05),but there was no significant difference between groups( P>0.05). Follow-up of 1-3 d,1 a after operation showed there were no significant differences between the two groups in the orthophoria rate,over-correction rate or under-correction rate( P>0. 05). CONCLUSION: In the treatment of children with complex strabismus by surgical correction of concomitant exotropia, the combined use of inferior oblique weakening procedures may not affect the correction effects of exotropia. When the surgery is designed,the impact of inferior oblique weakening procedures can be ignored.
引文
1 Shahpari M. Reduction of squint in the slant polarised phased array antennas. Electron Lett 2017;53(20):1345-1346
2尹秋凤,李芳珍,张玉珍,等.3D-FIESTA序列在儿童复杂性斜视中的应用价值.医学影像学杂志2016;26(10):1778-1781
3 Li G, Zhao H,Hui H. Beam squint compensation for hybrid precoding in millimetre-wave communication systems. Electron Lett 2018; 54(14):905-907
4 Shahvarpour A,Caloz C,Alvarez-Melcon A. Broadband and lowbeam squint leaky wave radiation from a uniaxially anisotropic grounded slab. Radio Sci 2016;46(4):1-13
5黄志昌,赵刚平,余建洪,等.斜视矫正术后儿童立体视觉恢复情况及影响因素分析.解放军预防医学杂志2017;35(8):989-991
6 Wang Y, Yang J, Li JW. Geometrical distortion correction for extremely high-squint parameter-adjusting synthetic aperture radar.Remote Sens Lett 2017; 8(3):254-261
7 Lions C, Colleville L, Bui-Quoc E,et al. Importance of visual inputs quality for postural stability in strabismic children. Neurosci Lett 2016; 617(23):127-133
8谢仁艺,杨梅,何欢,等.眼轴长度对共同性外斜视矫正手术量的影响.中国斜视与小儿眼科杂志2016;24(2):20-22
9谢小华,吕露,杜东成,等.共同性斜视再次手术的术式和手术矫正量.国际眼科杂志2016:16(7):1394-1396
10殷小龙,熊伟伟,邓燕,等.儿童外斜视手术前后多焦视觉诱发电位的变化.眼科新进展2016;36(7):647-651
11肖志刚.水平肌加强减弱术联合下斜肌切断减弱术治疗小儿斜视的临床效果研究.临床眼科杂志2017;25(2):154-156
12邬丹,陈琳琳.62例共同性外斜视手术治疗效果临床分析.中国斜视与小儿眼科杂志2016;24(1):45,55
13乔珊丽,陈静,孙常峰.共同性外斜视手术矫正临床效果观察.山西医药杂志2016;45(3):290-292
14殷小龙,邓燕,廖瑜俊,等.不同年龄段儿童共同性外斜视手术的近远期效果追踪.中国实用眼科杂志2016;34(4):350-353
15闫瑾,王利华.下斜肌减弱术对儿童青少年外斜视手术疗效的影响.中华眼视光学与视觉科学杂志2015;17(4):217-220
16赵晔,刘志峰.儿童共同性外斜视矫正后的预后情况分析.西南国防医药2016:26(8):878-881
17郭智一,许江涛.儿童共同性外斜视矫正术后立体视觉康复的临床观察.中国斜视与小儿眼科杂志2016;24(1):5-8
2尹秋凤,李芳珍,张玉珍,等.3D-FIESTA序列在儿童复杂性斜视中的应用价值.医学影像学杂志2016;26(10):1778-1781
3 Li G, Zhao H,Hui H. Beam squint compensation for hybrid precoding in millimetre-wave communication systems. Electron Lett 2018; 54(14):905-907
4 Shahvarpour A,Caloz C,Alvarez-Melcon A. Broadband and lowbeam squint leaky wave radiation from a uniaxially anisotropic grounded slab. Radio Sci 2016;46(4):1-13
5黄志昌,赵刚平,余建洪,等.斜视矫正术后儿童立体视觉恢复情况及影响因素分析.解放军预防医学杂志2017;35(8):989-991
6 Wang Y, Yang J, Li JW. Geometrical distortion correction for extremely high-squint parameter-adjusting synthetic aperture radar.Remote Sens Lett 2017; 8(3):254-261
7 Lions C, Colleville L, Bui-Quoc E,et al. Importance of visual inputs quality for postural stability in strabismic children. Neurosci Lett 2016; 617(23):127-133
8谢仁艺,杨梅,何欢,等.眼轴长度对共同性外斜视矫正手术量的影响.中国斜视与小儿眼科杂志2016;24(2):20-22
9谢小华,吕露,杜东成,等.共同性斜视再次手术的术式和手术矫正量.国际眼科杂志2016:16(7):1394-1396
10殷小龙,熊伟伟,邓燕,等.儿童外斜视手术前后多焦视觉诱发电位的变化.眼科新进展2016;36(7):647-651
11肖志刚.水平肌加强减弱术联合下斜肌切断减弱术治疗小儿斜视的临床效果研究.临床眼科杂志2017;25(2):154-156
12邬丹,陈琳琳.62例共同性外斜视手术治疗效果临床分析.中国斜视与小儿眼科杂志2016;24(1):45,55
13乔珊丽,陈静,孙常峰.共同性外斜视手术矫正临床效果观察.山西医药杂志2016;45(3):290-292
14殷小龙,邓燕,廖瑜俊,等.不同年龄段儿童共同性外斜视手术的近远期效果追踪.中国实用眼科杂志2016;34(4):350-353
15闫瑾,王利华.下斜肌减弱术对儿童青少年外斜视手术疗效的影响.中华眼视光学与视觉科学杂志2015;17(4):217-220
16赵晔,刘志峰.儿童共同性外斜视矫正后的预后情况分析.西南国防医药2016:26(8):878-881
17郭智一,许江涛.儿童共同性外斜视矫正术后立体视觉康复的临床观察.中国斜视与小儿眼科杂志2016;24(1):5-8