斜肌肌腱劈裂延长术在A型斜视治疗中的临床应用

Clinical application of superior oblique split tendon lengthening in the treatment for A-pattern strabismus with superior oblique over activity

目的探讨上斜肌肌腱劈裂延长术矫正伴有上斜肌功能亢进的A型斜视的效果。观察术后水平斜度的矫治以及对眼球旋转状态的影响和术后代偿头位的改善。方法对2012年1月至2013年12月在本院就诊,施行此手术,随访资料完善的21例A型斜视,其中,A型外斜12例,A型内斜9例（排除单侧上斜肌亢进的A征内外斜,Broun综合征和Helveston综合征）。双侧上斜肌定量延长,观察术后,对A型外斜,A型内斜水平斜度改善的影响,以及患者客观旋转角度和代偿头位的改善。使用Spss17.0统计软件对结果进行统计学分析。结果 21例A型斜视行双侧上斜肌肌腱劈裂延长术的患者,平均随访11个月。术前外斜A征斜视度平均为（25.62±10.06）-△,手术减少了（26.60±11.22）△。术前内斜A征的斜视度,平均为（34.21±15.04）-△,手术减少了（33.40±14.38）-△两组在A征的矫正量上差异无统计学意义（r=0.21,P=0.24）。术前眼底照FDA测算客观旋转度,平均右眼in14.21O,左眼in15.37°,术后3个月右眼in5.10°,左眼in4.92°。术后13例代偿头位消失,2例好转,1例无改善。结论伴有上斜肌亢进的A型斜视,上斜肌肌腱劈裂延长术,是矫正A型斜视的有效手术方法,对A型内、外斜视水平斜度无明显影响,在设计水平斜视度矫治方案时,可不额加斜肌对水平斜度的影响。对客观眼球旋转度和代偿头位有明显改善。

Objective To investigate the efficacy of superior oblique split tendon lengthening as the treatment for A-pattern strabismus with superior oblique over activity. Methods In this study 21 A-pattern strabismus patients who received quantitative bilateral superior oblique split tendon lengthening with complete follow-up data from Jan 2012 to Dec2013 were enrolled. Among these patients,12 were outward strabismus and 9 were inward strabismus. Patients with unilateral superior oblique over activity,Broun syndrome or Helveston syndrome were excluded. Correction of horizontal deviation,changes in eyeball rotation and improvement in compensatory head posture was observed. Data were analyzed using SPSS 17. 0. Results Average follow-up was 11-month long. Average deviation in outward strabismus was（ 25. 62 ± 10.06）△before surgery and was（ 26. 60 ± 11. 22）△after surgery. Average deviation in inward strabismus was（ 34. 21 ± 15.04）△before surgery and was（ 33. 40 ± 14. 38）△after surgery. There was no significant difference in correction amount between the 2 groups. Average objective rotation measured by fundus FDA was in14. 21△for right eye and in15. 37△for left eye before surgery. At 3 months after surgery,it improved to in5. 10△for right eye and in4. 92△for left eye. Compensatory head posture was corrected in 13 patients,improved in 2 patients improved,and remained unchanged in only 1 patient.Conclusions Superior oblique split tendon lengthening is an effective way to treat A-pattern strabismus with superior oblique over activity. It has no obvious effects on horizontal deviation. Objective rotation and compensatory head posture improved significantly. Extra oblique effect on horizontal deviation could be eliminated when designing treatment plan.