不同术式在V征治疗中的观察

The clinical analysis of the patients with V-patterns operated by two methods

目的 观察下斜肌切断或部分切除术和水平直肌垂直移位术在V征治疗中的疗效.方法 44例V征患者中,其中内斜V征13例,外斜V征31例.有下斜肌亢进患者34例,无下斜肌亢进患者10例.在34例下斜肌亢进患者中,30例亢进程度（＋＋～＋＋＋）,4例亢进程度（＋）.30例亢进程度（＋＋～＋＋＋）患者中,28例行下斜肌切断或部分切除术,2例行下斜肌部分切除加水平直肌移位术,4例亢进程度（＋）和10例无下斜肌亢进患者行水平直肌垂直移位术.所有患者常规矫正相应的水平斜视度.观察手术前、后斜视度数,上、下注视25°时斜视度数的差值,代偿头位的变化.平均随访时间4.2周.结果 28例行下斜肌切断或部分切除术患者,术后V征消失率82.14%,缓解率10.71%,存在率7.15%.2例行下斜肌切断加部分切除同时行水平直肌垂直移位术.术后V征全部消失.对4例下斜肌亢进程度（＋）和10例无下斜肌亢进患者行水平直肌垂直移位术.术后V征消失率78.57%,缓解率14.28%,存在率8.25%.有代偿头位患者8例,6例术后头位消失,2例头位缓解.结论 根据V征的不同术前检查及V征的大小不同,采取不同的手术方式,可以取得满意的效果.

Objective To investigate the inferior obliquus weakening procedure or horizontal rectus vertical transposition used in V-pattems. Methods There were 13 cases of V-esotropia and 31 cases of V-exotropia. There were 34 cases of inferior obliquus overaction and 10 cases without that. The inferior obliquus weakening procedure used for overaction of inferior obliquus ＋＋～＋＋＋ in 28 cases and the other 2 cases for inferior obliquus weakening procedure combined with horizontal rectus vertical transposition. And the horizontal rectus vertical transposition for overaction of inferior obliquus ＋ were in 4 cases and 10 cases without that.Then we analyzed the strabismus degree and head position of compensation before and after surgery. Results The rate of disappearance for V-patterns was 82.14% in 28 cases and the remission rate was 10.71%, the existence rate was 7.15%. After operation the V-patterns disappeared completely for 2 cases with combined surgery. For other 4 cases and 10 cases the rate of disappearance was 78.57%, the remission rate was 14.28% and the existence rate was 8.25%. For 8 cases with head position of compensation, there were 6 cases disappearance and 2 cases remission. Conclusions The V-patterns can be correct by surgery according to the V-patterns features.