改良Parks切口直肌调整缝线术对儿童水平斜视术后眼球屈光状态变化的影响探究
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摘要
目的探讨改良Parks切口直肌调整缝线术对儿童水平斜视术后眼球屈光状态变化的影响。方法选取2016年1月至2017年9月本院收治的110例(147眼)水平斜视患儿为研究对象。按照简单随机法将入选患儿分为对照组和观察组,每组各55例。对照组患儿采用常规切口进行直肌调整缝线术,观察组患儿采用改良Parks切口进行直肌调整缝线术。比较两组患儿的治疗效果、手术前后眼球屈光度和角膜曲率差值以及并发症发生情况。结果观察组患儿治疗有效率显著高于对照组(P <0.05)。术后1周,观察组患儿手术前后球镜屈光度差值大于对照组(P <0.05);术后1个月、2个月、4个月、8个月,两组患儿手术前后球镜屈光度差值比较均无显著差异(P_均> 0.05)。术后1周和1个月,观察组患儿柱镜屈光度差值均显著大于同期对照组(P_均<0.05);术后2个月、4个月、8个月,两组患儿柱镜屈光度差值比较均无显著差异(P_均> 0.05)。术后1个月,观察组患儿中央、鼻侧、颞侧、下方角膜曲率差值大于对照组(P_均<0.05),两组患儿上方角膜曲率差值比较无显著差异(P> 0.05);术后2个月,两组患儿中央、鼻侧、颞侧、上方、下方角膜曲率差值比较均无显著差异(P_均> 0.05)。两组患儿不良反应发生率比较无显著差异(χ~2=0.927,P> 0.05)。结论改良Parks切口直肌调整缝线术治疗儿童水平斜视效果显著,可改善眼球屈光度,且安全性较高,值得推广应用。
Objective To investigate the effect of improved Parks incision rectus muscle adjusting suture on the refractive state of children after horizontal strabismus surgery. Method From January 2016 to September 2017, 110 children(147 eyes) with horizontal strabismus admitted to our hospital were selected as subjects. They were divided into two groups according to the simple random method, 55 cases in each group. Control group children were treated with rectus adjustment suture through conventional incision. Observation group children were treated with improved Parks incision to rectus adjustment suture. The therapeutic effect, the difference of diopter and corneal curvature before and after operation, and the incidence of complications were compared between the two groups. Result The effective rate of treatment in observation group was significantly higher than that in control group(P < 0.05). One week after operation, the difference of spherical diopter before and after operation in observation group was larger than that in control group(P < 0.05); 1 month, 2 months, 4 months and 8 months after operation, there were no significant differences in the spherical diopter between the two groups(P_(all)> 0.05). 1 week and 1 month after operation, the changes of columnar refraction in observation group were significantly larger than those in control group(P_(all)< 0.05); there were no significant differences in the difference of columnar refraction between the two groups at 2, 4 and 8 months after operation(P_(all)> 0.05). 1 month after operation, the difference of corneal curvature between the central, nasal, temporal and inferior corneas in observation group was larger than that in control group(P_(all)<0.05), but there was no significant difference in the difference of corneal curvature between the two groups(P > 0.05). 2 months after operation, there were no significant differences in the difference of corneal curvature between the two groups in central, nasal, temporal, upper and lower corneas(P_(all)> 0.05). There was no significant difference in the incidence of adverse reactions between the two groups(χ~2= 0.927, P > 0.05). Conclusion Improved Parks incision rectus adjusting suture for children with horizontal strabismus has significant effect, can improve the diopter of the eyeball, and high safety, it is worth popularizing and applying.
Objective To investigate the effect of improved Parks incision rectus muscle adjusting suture on the refractive state of children after horizontal strabismus surgery. Method From January 2016 to September 2017, 110 children(147 eyes) with horizontal strabismus admitted to our hospital were selected as subjects. They were divided into two groups according to the simple random method, 55 cases in each group. Control group children were treated with rectus adjustment suture through conventional incision. Observation group children were treated with improved Parks incision to rectus adjustment suture. The therapeutic effect, the difference of diopter and corneal curvature before and after operation, and the incidence of complications were compared between the two groups. Result The effective rate of treatment in observation group was significantly higher than that in control group(P < 0.05). One week after operation, the difference of spherical diopter before and after operation in observation group was larger than that in control group(P < 0.05); 1 month, 2 months, 4 months and 8 months after operation, there were no significant differences in the spherical diopter between the two groups(P_(all)> 0.05). 1 week and 1 month after operation, the changes of columnar refraction in observation group were significantly larger than those in control group(P_(all)< 0.05); there were no significant differences in the difference of columnar refraction between the two groups at 2, 4 and 8 months after operation(P_(all)> 0.05). 1 month after operation, the difference of corneal curvature between the central, nasal, temporal and inferior corneas in observation group was larger than that in control group(P_(all)<0.05), but there was no significant difference in the difference of corneal curvature between the two groups(P > 0.05). 2 months after operation, there were no significant differences in the difference of corneal curvature between the two groups in central, nasal, temporal, upper and lower corneas(P_(all)> 0.05). There was no significant difference in the incidence of adverse reactions between the two groups(χ~2= 0.927, P > 0.05). Conclusion Improved Parks incision rectus adjusting suture for children with horizontal strabismus has significant effect, can improve the diopter of the eyeball, and high safety, it is worth popularizing and applying.
引文
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[15]Asproudis I,Kozeis N,Katsanos A,et al.A Review of Minimally Invasive Strabismus Surgery(MISS):Is This the Way Forward?[J].Adv Ther,2017,34(4):826-833.
[16]王娟,韩惠芳,刘素江.显微镜下Parks切口斜视矫正术治疗水平共同性斜视的临床研究[J].中国临床实用医学,2017,8(2):68-69.
[17]何菁.可调整缝线在先天性内斜视手术中的效果分析[J].中国医学前沿杂志(电子版),2015,7(8):108-110.
[18]石晶,谭小波,杨洁,等.三种斜视矫正手术患者术后眼球屈光状态变化[J].山东医药,2016,56(39):97-99.
[19]Wan MJ,Mantagos IS,Shah AS,et al.Comparison of Botulinum Toxin With Surgery for the Treatment of Acute-Onset Comitant Esotropia in Children[J].Am J Ophthalmol,2017,176:33-39.
[2]刘斐.显微镜下斜视矫正手术治疗斜视的临床效果[J].中外医疗,2016,35(22):5-8.
[3]刘贺婷,陶黎明,万茜茜,等.显微斜视手术和传统斜视手术临床疗效的比较[J].临床眼科杂志,2013,21(3):267-269.
[4]瞿明超.显微镜下斜视矫正手术治疗斜视的临床疗效分析[J].现代诊断与治疗,2017,28(17):3249-3250.
[5]陈春明,吴平波,钟红.改良Parks切口在显微斜视手术中的应用[J].中华眼外伤职业眼病杂志,2016,38(7):550-552.
[6]夏群.正确评估临床斜视治疗的效果[J].中华眼科杂志,2005,41(7):581-582.
[7]Zhou F,Ouyang M,Ma D,et al.Combined Surgery for Simultaneous Treatment of Congenital Ptosis and Coexisting Strabismus[J].J Pediatr Ophthalmol Strabismus,2017,54(5):288-294.
[8]Choi SW,Lee JY,Lew H.Customized Orbital Decompression Surgery Combined with Eyelid Surgery or Strabismus Surgery in Mild to Moderate Thyroid-associated Ophthalmopathy[J].Korean J Ophthalmol,2016,30(1):1-9.
[9]Kattan JM,Velez FG,Demer JL,et al.Relationship Between Binocular Summation and Stereoacuity After Strabismus Surgery[J].Am J Ophthalmol,2016,165:29-32.
[10]Coats DK.Strabismus surgery complications[J].Int Ophthalmol Clin,2010,50(4):125-135.
[11]王晓兰.显微斜视矫正手术与传统手术治疗斜视的疗效观察[J].中国医药指南,2016,14(26):10-11.
[12]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[J].解放军预防医学杂志,2017,35(8):989-991.
[13]张晖,唐宁,李燕利,等.斜视矫正手术对双眼视觉功能影响的临床研究[J].现代生物医学进展,2014,14(5):895-898.
[14]Merino P,Blanco Domínguez I,Gómez de Lia?o P.Outcomes of minimally invasive strabismus surgery for horizontal deviation[J].Arch Soc Esp Oftalmol,2016,91(2):69-73.
[15]Asproudis I,Kozeis N,Katsanos A,et al.A Review of Minimally Invasive Strabismus Surgery(MISS):Is This the Way Forward?[J].Adv Ther,2017,34(4):826-833.
[16]王娟,韩惠芳,刘素江.显微镜下Parks切口斜视矫正术治疗水平共同性斜视的临床研究[J].中国临床实用医学,2017,8(2):68-69.
[17]何菁.可调整缝线在先天性内斜视手术中的效果分析[J].中国医学前沿杂志(电子版),2015,7(8):108-110.
[18]石晶,谭小波,杨洁,等.三种斜视矫正手术患者术后眼球屈光状态变化[J].山东医药,2016,56(39):97-99.
[19]Wan MJ,Mantagos IS,Shah AS,et al.Comparison of Botulinum Toxin With Surgery for the Treatment of Acute-Onset Comitant Esotropia in Children[J].Am J Ophthalmol,2017,176:33-39.
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