下斜肌减弱术对儿童青少年外斜视手术疗效的影响

The effect of an inferior oblique muscle weakening procedure on surgical alignment in children and adolescents with exotropia

目的 比较儿童青少年外斜视手术联合或不联合下斜肌减弱术的效果.方法 回顾性病例系列研究.收集2009年8月至2011年9月期间按照常规外斜视手术量住院行外斜视矫正手术的连续性病例179例,根据其外斜视矫正手术是否联合下斜肌减弱术,分为联合下斜肌减弱术组（A组,48例）和不联合下斜肌减弱术组（B组,131例）,比较2组术后近期（1～3 d）及远期（≥6个月）随访时的眼位正位率、过矫率及欠矫率.计数资料行χ2检验,计量资料行独立样本t检验.结果 术后近期随访A组眼位正位率、过矫率、欠矫率分别为73％、23％和4％,B组分别为72％、21％和6％ （χ2=0.276,P＞0.05）;术后远期随访A组眼位正位率、过矫率、欠矫率分别为62％、6％和31％,B组分别为69％、5％和26％（χ2=0.807,P＞0.05）,2组术后近期及远期随访手术疗效的差异均无统计学意义.结论 在儿童外斜视矫正手术中,联合下斜肌减弱术对外斜视的矫正效果可能无影响,可按术前水平斜视度设计手术量.

Objective To compare the outcomes of surgery for exotropia and surgery for exotropia combined with an inferior oblique muscle weakening procedure in children and adolescents.Methods In a retrospective study,179 cases of the children underwent conventional horizontal muscle surgery for exotropia from August 2009 to September 2011 were included.All children were divided into two groups based on whether or not they underwent an inferior oblique weakening procedure：group A included 48 patients who underwent surgery for exotropia combined with an inferior oblique weakening procedure,and group B included 131 patients who were only treated with surgery for exotropia.The success rates of alignment,overcorrection,and under-correction were compared between the 2 groups at postoperative days 1 to 3 and then at the final follow-up （a minimum of 6 months）.Enumeration data were analyzed with a χ2 test,measurement data were analyzed with an independent samples t test.Results At postoperative days 1 to 3,the success rates of alignment were 73% and 72%,the over-correction rates were 23% and 21%,and the under-correction rates were 4% and 6% in groups A and B,respectively （χ2=0.276,P〉0.05）.At the final follow-up,the success rates of alignment were 62% and 69%,the over-correction rates were 6% and 5%,and the under--correction rates were 31% and 26% in groups A and B,respectively （χ2=0.807,P〉0.05）.There was no significant difference in surgical outcomes between groups A and B at postoperative days 1 to 3 and at the final follow-up.Conclusion The inferior oblique muscle weakening procedure might have no significant effect on surgical alignment in children with exotropia.Eye surgeons may not need to change the conventional parameters of muscle strabismus surgery for horizontal exodeviations when inferior oblique muscle weakening procedures are simultaneously performed.