探讨Ⅴ型外斜与分开过强型外斜视相互关系及治疗方案

Investigation of the relationship between V-pattern exotropia and divergence excess pattern exotropia and treatments of V-pattern exotropia

目的探讨V型外斜与分开过强型外斜视的相互关系及治疗方案。方法临床病例对照研究。对2008年6月至2012年12月在南昌大学医学院一附院眼科经三棱镜交替遮盖法检查确诊的32例非斜肌功能异常外斜视V征患者中24例合并分开过强型外斜视，按入院顺序随机分2组，分别实施水平肌后退与缩短并斜行重置术12例（A组）与常规的水平肌后退与缩短术12例（B组）。观察其术前与术后的眼位、眼肌功能、旋转斜、双眼视功能等。结果所有患者v征消失，双眼球运动无障碍，无旋转不适，A组7例、B组5例有双眼视功能改善。结论水平肌后退／缩短并斜行重置术（A组）与常规的水平肌后退／缩短术（B组）治疗合并分开过强型外斜视的V征效果良好，A组治疗效果较B组差异有统计学意义（t=2．68，P〈0．05），更适合治疗合并分开过强型外斜视的非斜肌因素的V征。

Objective To investigate the relationship between V-pattern exotropia and divergence excess pattern exotropia and evaluate the effects of two different surgical procedures of V-pattern exo- tropia. Methods Twenty-four of 32 non-parafunctional of oblique muscle typed patients who were definitely diagnosed by triple prism alternative cover test, had divergence excess pattern strabismus. The 24 cases were randomly divided into 2 groups, patients in group A selected surgery of slanting the horizontal rectus muscle insertions after recession or resection of the horizontal rectus muscles （Group A）, group B selected conventional surgery of recession or resection of the horizontal rectus muscles, the position of the eyeball, fianction of extraocular muscles and spinfunction, visual fimction of both eyes before and after surgery were observed. Results V patterns disappeared after operations in all patients. Ocular movement was no disability, rotation discomfort was undiscovered; 7 cases in group A got improved biocular fimctions, 5 cases in group B. 75% of Non-oblique parafunctional V-pattern exotropia incorporate with divergence excess pattern exotropia. Both surgery of slanting the horizontal rectus muscles insertions surgery （Group A） and recession or resection of the horizontal rec- tus muscles surgery （Group B） are effective methods to V-pattern exotropia with non-paraftmctional oblique muscle. There is significantly difference between group A and group B. Conclusions Surgery of slanting the horizontal rectus muscle insertions is more effective than conventional surgery of the horizontal rectus muscles to V-pattern exotropia with non-parafunctional oblique muscle.