儿童连续性内斜视外直肌加强手术量效关系的研究

Dose-effect relationship for lateral rectus muscle advancement in consecutive esotropia in children

目的评价儿童连续性内斜视（consectiveesotropia）外直肌加强手术效果与手术量之间的量效关系。方法儿童连续性内斜视进行外直肌加强手术¨例14只眼，均为外直肌复位或缩短后复位手术。男7例，女4例，年龄4—14岁。应用三棱镜遮盖试验分别检查术前的斜视度和术后1周的斜视度，同时计算外直肌复位和缩短的手术量。应用SPSS11．5统计分析计算出外直肌加强手术治疗连续性内斜视的“量效”关系。结果11例连续性内斜视，单眼外直肌加强手术8例，双眼外直肌加强手术3例，所有患儿均伴有外转受限，术前平均斜视度三棱镜度为（31．00±10．53）PD，术后1周的平均斜视度为（-3．00±7．97）PD，平均的矫正率为（3．97±1．33）PD／mm。6例外直肌单纯复位和5例缩短后复位者“量效”关系两组之间的秩和检验差异无统计学意义（P=0．410）。术前斜视度与量效关系的相关系数r=5．74，相关性P=0．655。结论连续性内斜视行外直肌的加强（缩短和复位）手术：“量效”关系为：（3．97±1．33）PD／mm，“量效”关系与术前的内斜视程度无关，单纯复位组与缩短后复位组量效关系尚未发现差异。

Objective To evaluate the dose-effect relationship for lateral rectus muscle advancement in consecutive esotropia in children. Methods Eleven cases （7 boys and 4 girls） with consecutive esotropia were retrospectively reviewed. All patients had undergone lateral rectus surgery. The alterations in muscle position and prism diopers （PD）and deviational change were determined by subtracting the angle of deviation 1 week after the operation. To quantify the clinical effect of muscle advancement, the ratio of the change in muscle position and reduction to the change in visual angle deviation was calculated （the surgical dose-effect relationship）. Results The mean age of 11 cases was （ 8.91 ＋ 3.01 ） years. Eight of 11 cases accepted lateral rectus muscle advancement in one eye and 3 of 11 cases accepted lateral rectus muscle advancement in two eyes. All patients were accompanied by the lateral limits. Strabismus degree was （31.00± 10.53） PD preoperatively and 1 week after the surgery the average strabismus degree was （3.00 ± 7.97） PD. The average correct rate was （ 3.97 ± 1.33） PD/mm. Rectus simply reset was in 6 cases and shorten reset was in 5 cases after the concentration-response. The difference in dose-effect relationship between the two groups had no statistical significance （P = 0. 410 ）. The correlation coefficient was 5.74 （P = 0.655）. Conclusion The dose-effect relationship for lateral rectus muscle advancement in consecutive esotropia in children is （3.97 ＋ 1.33 ） PD/mm, and the dose-effect relationship has nothing to do with the degree of preoperative esotropia. The dose-effect relationship has no statistically significant difference between simply reset and shorten reset groups.