脑性瘫痪患儿斜视A征的临床特点与手术疗效分析

Clinical Characteristics and Surgical Efficacy of Strabismus Sign A in Children with Cerebral Palsy

目的分析脑性瘫痪(脑瘫)患儿斜视A征的临床特点与手术疗效。方法选取2014年4月至2016年12月我院收治的脑瘫伴发斜视A征患儿55例(其中30例双眼发病,25例单眼发病,共85眼),比较内斜视A征、外斜视A征患儿临床资料;予上斜肌减弱术(上斜肌肌腱延长)后比较患儿术后1周和1个月内术眼屈光状态变化(球镜、柱镜、等效球镜、散光轴位、散光值等);术前与术后12个月上下眼位斜度差及斜度差减少量。结果内斜视A征患儿发病年龄、双眼同时视占比、痉挛型运动障碍比例、胎龄及出生体重低于外斜视A征患儿,无立体视分布比例高于外斜视A征患儿(P<0.05)。术后1周,患儿等效球镜屈光度、角膜闪光值较术前1d增加(P<0.05),但术后1个月屈光状态逐渐恢复,与术前比较差异无统计学意义(P>0.05)。术后12个月,患儿手术矫正成功率为78.18%(43/55),其中有12例痉挛性脑瘫患儿发生不同程度回退。结论胎龄小、出生体重轻的脑瘫患儿易并发内斜视A征,且双眼视功能、立体视功能破坏较外斜视A征患儿严重;行上斜肌减弱术可有效改善斜视A征情况;痉挛性脑瘫患儿眼外肌力量往往较普通斜视患儿强,手术设计量需根据实际情况进行调整避免二次调位。

Objective To analyze the clinical features and operative effect of oblique A sign in children with cerebral palsy（ Cerebral palsy）.Methods From April 2014 to December 2016,55 children with cerebral palsy accompanied with strabismus sign A treated in our hospital were selected（ including 30 cases of binocular disease,25 cases of monocular disease,a total of 85 eyes）.The clinical data of children with esotropia sign A and exotropia sign A were compared; After superior oblique muscle weakening（ lengthening of superior oblique muscle tendon）,the changes of refractive state（ spherical mirror,cylindrical mirror,equivalent spherical mirror,astigmatism axis,astigmatism value,etc.） were compared between 1 week and 1 month after operation; 12 months before and after the operation,the deviation of the upper and lower ocular positions and the decrease of the deviation were compared.Results The age of onset of children with esotropia sign A,the proportion of binocular vision,the proportion of spastic motor disorder,gestational age and birth weight were lower than those of exotropia sign A,and the distribution of no stereopsis was higher than that of exotropia sign A（ P〈0. 05）.1 week after operation,the equivalent spherical refraction and corneal flash value increased significantly than that of 1 week before operation（ P〈0. 05）,but the refractive state gradually recovered 1 month after operation,no significant difference between before and after operation（ P〈0. 05）.12 months after surgery,the success rate of surgical correction was 78. 18 %（ 43/55）.Among them,12 children with spastic cerebral palsy had different degrees of retrogression. Conclusion Children with cerebral palsy with small gestational age and low birth weight tend to be complicated with esotropia A sign,and the damage of binocular visual function and stereopsis visual function is more serious than that of children with exotropia A sign; Superior oblique muscle weakening can effectively improve strabismus A sign; The strength of the extraocular muscles in spastic cerebral palsy children is usually stronger than that in the common strabismus children.The operation design should be adjusted according to the actual situation to avoid the secondary adjustment.