超常量内直肌后退术治疗大度数内斜视的疗效

Clinical effect of super quantity of medial rectus recession in treating large angle esotropia

目的:观察双眼内直肌超常量后退术治疗大度数非调节性的共同性内斜视的临床效果。方法:回顾分析81例大度数共同性内斜视,按手术方式不同分为观察组(内直肌超常量后退)和对照组(内直肌常规量后退),评价其手术肌肉条数、术后1wk及1a的眼位和眼球内转功能。结果:观察组行双眼内直肌后徙术43例,双眼内直肌后徙+单眼外直肌缩短术5例;对照组行双眼内直肌后徙术6例,双眼内直肌后徙+单眼外直肌缩短术21例,双眼内直肌后徙+双眼外直肌缩短术6例。手术肌肉条数比较两组之间差异有统计学意义(χ2=41.72,P<0.01)。术后1wk,观察组眼位-2△～+12△,平均+6.52△±3.23△,对照组眼位-3△～+10△,平均+5.38△±2.46△,两组比较差异无统计学意义(t=1.45,P=0.08);术后1a,观察组眼位-5△～+10△,平均+4.57△±2.71△,对照组-5△～+8△,平均+3.92△±2.15△,两组比较差异无统计学意义(t=1.23,P=0.10)。术后1wk,观察组有14例,对照组有6例内转功能受限;术后1a,观察组有5例,对照组有2例内转功能受限,两组比较差异均无统计学意义(χ2=1.27,P>0.05;χ2=0.47,P>0.05)。结论:超常量内直肌后退术治疗大度数共同性内斜视可减少手术肌肉条数,他对眼球内转功能无明显影响。

AIM： To observe the clinical effect of super quantity of binocular medialrectus in treating large angle concomitant esotropia. METHODS： Eighty-one patients with large angle concomitant esotropia were analyzed retrospectively. According to the operation method, they had been divided into observation group （large recession of rectus muscle） and control group （normal recession of rectus muscle）. The number of muscle were evaluated, eyes position and involution function in a week and a year after operation were also evaluated. RESULTS：Forty-three cases in observation group had binocular medial rectus treatment, while 5 cases had binocular medial rectus＋monocular medial rectus muscle resection treatment. Six cases in control group had the surgical treatment of bilateral medial rectus recession, 21 cases had binocular medial rectus＋monocular medial rectus muscle resection and 6 cases with binocular medial rectus＋bilateral lateral rectus shortening. The difference of the muscles numbers of two groups in operation had statistical significance （χ2=41.72, P0.01）. One week after the operation, eye position of observation group was -2△~＋12△, the average was ＋6.52△±3.23△, while that of control group was -3△~＋10△, the average was ＋5.38±246△. The difference of two groups had no statistical significance （t=1.45, P=0.08）. One year after operation, eye positions of observation group and control group were -5△~＋10△（average： ＋4.57△±2.71△） and -5△~＋8△（average： ＋3.92△±2.15△）. The difference of two group had no statistical significance （t=1.23, P=0.10）. One week after the operation, 14 cases of observation group and 6 cases of control groups involution function were limited. One year after operation, 5 cases of observation group and 2 cases of control groups involution function were limited. The differences of two group had no statistical significance （χ2=1.27, P0.05;χ2=0.47, P0.05）. CONCLUSION： Super quantity of medial rectus recession in treating large angle concomitant esotropia can reduce the muscles number, but it has no obvious influence on eyeballs involution function.