下斜肌转位术与下斜肌切断术治疗斜视V征的比较

Anterior transposition compared to disinsertion of the inferior oblique muscle for V-pattern strabismus

目的比较下斜肌转位术（AT）与下斜肌切断术在治疗下斜肌功能亢进引起的斜视v征的作用。方法回顾性分析行下斜肌转位术治疗的伴有下斜肌功能亢进，同时合并分离垂直性斜视（DVD）的28例斜视V征患者，术前下斜肌功能亢进程度为＋1～＋3，V征差值不超过30PD，根据双眼下斜肌功能亢进对称性以及双眼或单眼行下斜肌转位术，分为双眼AT组（15例）和单眼AT组（13例），与历史同期行下斜肌切断术治疗的伴有下斜肌功能亢进，不合并DVD的28例斜视v征患者进行非随机对照研究，对照组根据下斜肌功能亢进对称性及双眼行对称或非对称下斜肌切断术，相应地分为对照1组（15例）和对照2组（13例），分别测量手术前后V征差值，比较手术矫正v征差值并进行统计学分析。结果双眼AT组平均矫正V征差值（15．67±4．03）三棱镜度（PD），对照1组平均矫正（15．20±3．51）PD，两组差异无统计学意义（t=0．338，P〉0．05）；单眼AT组平均矫正V征差值（14．69±3．71）PD，对照2组平均矫正（14．00±3．94）PD，两组差异无统计学意义（t=0．462，P〉0．05）。结论下斜肌转位术与下斜肌切断术治疗下斜肌功能亢进引起的v征斜视疗效无差别。

Objective To compare the efficacy of anterior transposition （AT） and disinsertion of the inferior oblique muscle （IO） in the treatment of V-pattern strabismus caused by inferior oblique overaction （IOOA）. Methods A retrospective nonrandomized control study was conducted for 28 consecutive patients with DVD who received AT surgery and 28 consecutive historical patients without DVD who received IO disinsertion to treat their V-pattern strabismus caused by IOOA respectively. The preoperative degree of IOOA was graded from ±1 to ±3 and the amount of V-pattern was not greater than 30PD. The bilateral AT group （ 15 patients） with symmetric IOOA underwent equal bilateral AT surgery, and the unilateral AT group （ 13 pa- tients） with asymmetric IOOA underwent unilateral AT surgery. Correspondingly, 28 control patients were classified as the control group 1 （ 15 patients） who received equal IO disinsertion and the control group 2 （ 13 patients） who received unequal IO disinsertion. The amount of V-pattern correction was compared and statisti- cally analyzed between the two comparative groups respectively. Results The amount of V-pattern correction was （ 15.67 ± 4.03） prism diopters （PD） in the bilateral AT group. This compared with （ 15.20 ± 3.51 ） PD in the control groupl, representing no statistically significant difference between the two groups （t=0.338, P〉 0.05 ）; similarly, the amount of V-pattern correction was （ 14.69 ± 3.71 ） PD in the unilatetal AT group. This compared with （ 14.00 ± 3.94） PD in the control group2, representing no statistically significant difference in outcome either （ t=-0.462, P〉 0.05）. Conclusions AT is at least as effective as disinsertion in the treatment of V-pattern strabismus caused by IOOA.