双侧斜肌减弱术对A—V征上下方斜度矫正的定量研究

Quantitative study of bilateral oblique muscle weakening to correct ＂A＂and ＂V＂ pattern upgaze and downgaze of deviation

目的探讨双侧斜肌减弱术对A～V征斜视上下方斜度矫正的定量研究。方法收集253例伴有双侧上（下）斜肌功能亢进的A—V征斜视，其中V征221例，A征32例，均行双侧上（下）斜肌减弱联合水平直肌后退和（或）缩短术。观察手术前后上下眼位的斜视度数、斜肌亢进程度、眼位、双眼视觉及A—V征斜视度与手术和术后残余量的量效关系。结果221例V征患者术前上、下眼位的斜视度数差平均为（25．69±9．27）△；手术平均减少了（23．24±9．42）△，随访末期残余斜度差平均为（2．45±6．37）△。对于外斜视V征，手术解决了（23．41±9．66）△。内斜视V征为（22．72±8．67）△。随访未期V征斜视矫正成功率为95．02％（210／221o32例A征患者术前上、下眼位的斜视度数差平均为（23．72±11．29）△；手术平均减少了（24．34±13．56）△，随访末期残余斜度差平均为：（-0．63±5．38）△。对于外斜视A征手术解决了（25．15±13．97）△。内斜视A征解决了（20．83±12．06）△。随访末期A征矫正成功率为96．88％（31／32）。结论伴有双侧斜肌亢进的A—V征斜视，行双侧斜肌减弱术可有效矫治A—V征斜视。虽然随着A—V征的偏斜度数增加，双侧斜肌减弱术所矫正的斜视度有所增加，但术后残余量也随之增加。

Objective To evaluate the quantitative study of bilateral oblique muscle weakening for ＂A＂ and ＂V＂ pattern.Methods We performed bilateral oblique muscle weakening associated recession and resection of medial or lateral rectus muscles.Pre-and post-operative upgaze and downgaze of deviation;oblique muscle overaction;position of eye as well as binocular visual function were evaluated in 253 A-V pattern patients （＂V＂ pattern,221 patients ; ＂A＂ pattern, 32 patients ）.The dose-effect relationship between deviation of A-V pattern and operation as well as post-operative residue.Results ＂V＂ pattern patients： The average V pat- tern was （25.69± 9.27）△ before and （2.45± 6.37 ）△after the operation.bilateral oblique muscle weakening reduced the V pattern in （23.24±9.42）△.for V exotropia with an average correction of （23.41± 9.66）△;V esotropia with a mean improvement of（22.72± 8.67 ）△.＂A＂ pattern patients： The average A pattern was（23.72± 11.29）△before and（-0.63±5.38 ）△ after the operation,operation reduced the A pattern in（24.34± 13.56）△.For A exotropia with an average correction of （25.15 ±13.97）△.for A esotropia with amean improvement of （20.83± 12.06）△.Concsions Bilateral oblique muscle weakening is a simple,safe and effective method for ＂A＇ and ＂V＂ pattern with bilateral oblique muscle overaction.Although following the deviation of ＂A＇ and ＂V＇ pattern increased.the degree of correction by operation is raised, and post-operative residue is also increased.