V型外斜视的临床特征和手术治疗

Clinic characteristics and surgical management in V-pattern deviation

目的:探讨V型外斜视的临床特点和手术方法及疗效方法:分析2003-01/2007-07在我院行手术治疗的93例V型外斜视患者,其中男51例,女42例,年龄4～27(平均13.2)岁,术后随访时间为6mo～4a,V征向上向下注视的斜视度之差最小为15△,最大相差100△,其中15～50△者85例,>50△者8例,第一眼位斜视角在-20～-110△,术前行同视机检查有双眼单视功能者18例。手术根据有无斜肌异常和V征的程度,在水平斜视矫正的同时,选择下斜肌切断或部分切除,直肌附着点垂直移位、及下斜肌部分切除并水平直肌垂直移位三种术式。结果:采用下斜肌断腱或部分切除术和水平直肌附着点移位均取得满意效果,下斜肌断腱或部分切除术适应于下斜肌亢进的外斜V型,垂直肌移位术适应因无下斜肌亢进的外斜V征,术后第一眼位正位者84例,V征消失者87例,双眼视功能恢复者达49例。结论:V型外斜视是一种常见的斜视类型,常合并水平斜视,发病原因以斜肌功能异常为主,可根据病因选择不同手术方式,手术不仅可以矫正眼位,而且有利用双眼单视功能的建立。

AIM： To study the clinic characteristics, surgical treatment and postoperative effect of V- pattern deviation. METHODS： The surgical effects of 93 patients with vpattern deviation （male 51, female 42）, treated in our hospital during January 2003 to July 2007, with ages ranging from 4 to 27 years （ meaning 13.2 years） were analyzed. Follow-up time after surgery was 6- 48 months. Viewing the differences between superior strabismus angles and inferior strabismus angles, 85 cases of askant difference were 15^△-50^△, and 8 cases of askant difference were more than 50^△. The smallest askant difference was 15^△, the greatest was 100^△. The cases of askant were between -20^△-100^△ at primary position of eye. Eighteen cases had binocular function by synoptophore test. According to dysfunction of oblique muscle and level of v- pattern, patients were treated with horizontal rectus vertical transporting, completely or partly inferior oblique reduction or horizontal rectus vertical transporting combined with inferior oblique reduction. RESULTS. Patients treated with horizontal rectus vertical transporting, partly inferior oblique reduction had satisfied results, The cases, with v-exotropia complicating overaction degrees of inferior oblique muscle, should be treated with partly inferior oblique reduction. If not complicating dysfunction of oblique muscles, case were treated with horizontal rectus vertical transporting. Eighty-four cases return normal at primary position of eye, 87 cases got v-sign correction and 49 case got binocular vision. CONCLUSION ： V- pattern deviation is a common type in strabismus. Its etiology is a mainly oblique muscle dysfunction. Different surgical procedures should be selected according to different etiological factors. Such surgical procedures should not only align the eye and also promote the binocular function.