垂直直肌分级断腱术治疗小度数垂直斜视的临床效果观察

Graded vertical rectus tenotomy for small angle vertical deviation

目的观察垂直直肌分级断腱术治疗小度数垂直斜视的临床效果。方法回顾性病例系列研究。收集2017年1月至2019年12月就诊于天津市眼科医院斜视与小儿眼科第一眼位小度数[≤10三棱镜度(PD)]垂直斜视的12例成年患者资料,其中男性8例,女性4例,年龄(48±8)岁,病程(15±7)个月。所有患者除外颅脑疾病和眼眶及眼外肌异常。采用三棱镜加交替遮盖法测量第一眼位斜视度数及双马氏杆试验测量主观旋转斜视角度。根据检查结果行鼻侧或颞侧上直肌或下直肌分级断腱术。观察术后第1天与末次随访时垂直斜视度数与旋转斜视角度的变化及垂直直肌断腱比例与垂直斜视矫正度数的关系。垂直斜视度数以M(Q_(1),Q_(3))表示,统计学分析主要采用Friedman检验(Bonferroni校正)及线性拟合分析。结果患者随访时间为(7±3)个月。术前第一眼位垂直斜视度数为7.00(5.25,7.75)PD,术后第1天为1.00(1.00,2.00)PD,末次随访时为1.50(1.00,2.00)PD,术后与术前比较差异均有统计学意义(P<0.001,P=0.003)。患者术后旋转斜视角度无明显变化。线性拟合分析显示垂直直肌断腱比例为50%~90%可矫正5~8 PD的垂直斜视(R^(2)=0.72;P<0.001)。结论垂直直肌分级断腱术能够有效改善小度数垂直斜视。

Objective To observe the effectiveness of the graded vertical rectus tenotomy procedure for small-angle vertical deviation.Methods Retrospective case series study.Twelve patients,including 8 males and 4 females,with an average age of(48±8)years were treated in Tianjin Eye Hospital from January 2017 to December 2019 for diplopia in primary gaze by strabismus surgery.The disease duration was(15±7)months.MRI/CT scan of the orbits and brain was performed to exclude the orbital and craniocerebral diseases.All patients underwent ocular movement examination,with the prism and alternate cover test to detect the deviation angle in primary gaze and the double Maddox test.Based on the results,the posterior segment of the nasal/temporal superior/inferior rectus muscle was operated.The changes of vertical and cyclotorsion deviation angle and the relationship between the vertical rectus graded tenotomy and corrected vertical deviation angle were observed at 1 day after surgery and the last follow-up.The vertical deviation angle was represented by M(Q_(1),Q_(3)).Friedman test(Bonferroni correction)and linear fitting analysis were used for statistical analysis.Results The follow-up time of all patients was(7±3)months.The vertical deviation angle in primary gaze before surgery[7.00(5.25,7.75)PD]was significantly different from that at 1 day after surgery[1.00(1.00,2.00)PD]and the last follow-up[1.50(1.00,2.00)PD](P<0.001,P=0.003).There was no significant difference in postoperative cyclotorsion in all patients.Linear fitting results showed that 50%to 90%vertical rectus tenotomy corrected 5 to 8 PD vertical deviation(R^(2)=0.72;P<0.001).Conclusion The graded vertical rectus tenotomy procedure can effectively improve the small-angle vertical deviation in primary gaze.