下斜肌转位术对伴有下斜肌亢进DVD的矫正作用

Anterior transposition of the inferior oblique muscle for correction of DVD with inferior oblique overaction

目的探讨下斜肌转位术对伴有下斜肌亢进的垂直分离性斜视（dissociated vertical deviation，DVD）原在位垂直斜视的矫正作用。方法应用下斜肌转位术治疗34例（46只眼）伴有下斜肌亢进DVD患者的垂直斜视，18例合并水平斜视者同期手术矫正，手术前后测量原在位垂直斜视度及下斜肌亢进程度，并进行统计学比较。结果原在位垂直斜视度5m远距离平均矫正（13．57±9．74）PD（t=9．450，P〈0．01），95％置信区间为（10．67，16．46）PD。33cm近距离平均矫正（13．28±9．98）PD（t=9．029，P〈0．01），95％置信区间为（10．32，16．25）PD。下斜肌亢进程度从术前平均＋2降至术后0（Wilcoxon符号秩检验，Z=5．957，P〈O．01），差异均具有统计学意义。结论下斜肌转位术是治疗伴有下斜肌亢进DVD的有效手段，合并之下斜肌亢进同时得以消除。

Objective To evaluate the correction of hypertropia in primary position with anterior transposition of the inferior oblique muscle （ATIO） for dissociated vertical deviation （DVD） with inferior oblique overaction. Methods 34 patients （46eyes） with DVD and concurrent with inferior oblique muscle overaction underwent the ATIO, 18 patients had horizontal strabismus, the horizontal deviation was corrected at the same operation. The amount of vertical deviation in primary position and inferior oblique overaction preand postoperation was measured and statistically analyzed. Results The mean correction of vertical deviation in primary position at 5 meters distance was （13.57±9.74）prism diopters （PD）（t =9.450, P〈0.01 ） and （ 13.28±9.98 ）PD （t=9.029, P =〈0.01 ） at 33 centimeters, the differences were statistically significant between the groups. The 95% confidence interval was（ 10.67, 16.46） PD and （10.32, 16.25 ）PD respectively. Mean inferior oblique action decreased from ＋2 to 0, the difference was statistically significant （Wilcoxon signed ranks test, Z=5.957, P〈0.01 ）. Conclusions ATIO is an effective method for correcting DVD with inferior oblique overaction, especially in elimination of the concurrent inferior oblique overaction.