上斜肌肌腱劈开延长术在上斜肌功能亢进引起的A型斜视中的应用

Application of Superior Oblique Split Tendon Lengthening in A-Pattern Strabismus Caused by Superior Oblique Overaction

目的:探讨上斜肌肌腱劈开延长术治疗上斜肌亢进A型斜视的安全性及有效性。方法:回顾性临床病例研究。收集和分析安徽医科大学第一附属医院眼科2020年6月至2021年6月行上斜肌肌腱劈开延长术8例(14眼)患者的术前术后临床资料。所有患者根据上斜肌亢进程度行上斜肌肌腱劈开延长术,上斜肌亢进+1者延长4~5 mm,+2者延长5~6 mm,+3者延长7~8 mm,+4者延长8~10 mm。观察手术对患者A型斜视、眼球客观旋转及立体视功能影响。正态分布数据采用配对t检验,非正态分布数据采用Mann Whitney检验,两变量间的相关性使用Spearman秩相关检验分析。结果:8例(14眼)行上斜肌肌腱劈开延长术,同时矫正患者水平斜视。其中2例患者行单眼上斜肌肌腱劈开延长术,6例患者行双眼上斜肌肌腱劈开延长术。除1例患者外,余患者术后A型斜视消失;所有患者术后上下转25°斜视度差较术前明显减小,6例双眼手术患者术后上下转25°斜视度差较术前[(22.5±9.4)PD]减小为[(3.3±10.1)PD](t=10.78,P<0.001),A型斜视矫正量为(19.2±4.4)PD;14眼术后上斜肌亢进程度[+0(0~0.2)]轻于术前[2.0(2.0~3.0)](U=6.50,P<0.001);客观旋转度使用Image-proplus 6.0软件进行测量,14眼术后旋转斜视(-0.6°±6.0°)较术前(+5.7°±5.7°)明显改善(t=6.98,P<0.001),旋转矫正量为6.3°±3.4°。术后所有患者均未出现继发性上斜肌麻痹及V型斜视改变。术前所有患者原在位均无立体视,术后2例患者获得原在位周边立体视(400″),1例患者获得中心凹立体视(20″)。结论:上斜肌肌腱劈开延长术可明显改善上斜肌亢进A型斜视,可改善患者客观内旋及部分患者原在位立体视功能,且术后不易继发上斜肌麻痹等并发症。

Objective:To investigate the safety and effectiveness of superior oblique split tendon lengthening in the treatment of A-pattern strabismus with superior oblique overaction.Methods:In this retrospective study,the clinical date of 8 cases(14 eyes),who underwent superior oblique split tendon lengthening from June 2020 to June 2021 in the First Affiliated Hospital of Anhui Medical University were retrospectively analyzed.All patients were treated with superior oblique split tendon lengthening according to the degree of superior oblique overaction,and the lengthening 4-5 mm for superior oblique overaction+1,5-6 mm for+2,7-8 mm for+3 and 8-10 mm for+4.To observe the effect of operation on A-pattern strabismus,objective eye rotation and stereoscopic vision,paired t test was used for normal distribution data,Mann Whitney test was used for non-normal distribution data,Spearman rank correlation test were used for analyze the correlation between two variables.Results:Eight cases(14 eyes)were treated with superior oblique split tendon lengthening and horizontal strabismus correction.Two patients underwent unilateral superior oblique split tendon lengthening,and six patients underwent bilaterally superior oblique split tendon lengthening.Except 1 patient,all the patients had no A pattern after surgery.Postoperative A-patterns was significantly reduced in all patients compared with preoperative.The average difference of pre-and post-operative A-patterns were 22.5±9.4 PD and 3.3±10.1 PD in 6 cases with bilaterally superior oblique overaction(t=10.78,P<0.001).The bilaterally superior oblique split tendon procedure could correct A-pattern in an amount of(19.2±4.4)PD.The average amount of pre-and post-operation superior oblique overaction were 2.0(2.0-3.0)and+0(0-0.2)in 14 eyes(U=6.50,P<0.001);Objective rotation was measured by image-proplus 6.0 software.In 14 eyes,the torsion was significantly improved after the operation compared with preoperative.The average pre-and post-operation objective rotation were+5.7°±5.7°and-0.6°±6.0°in 14 eyes(t=6.98,P<0.001).The average corrected rotation was 6.3°±3.4°.None of the patients had secondary superior oblique palsy and V-pattern after surgery.All patients had no stereopsis in the original position before surgery,2 patients received original peripheral stereoscopic vision(400")and 1 patient received fovea stereoscopic vision(20").Conclusions:Superior oblique split tendon lengthening is effective in the treatment of superior oblique overaction and A-pattern,which can correct objectively in-torsion and stereoscopic vision of some patients,and is less likely to cause secondary complications such as superior oblique palsy.