下斜肌减弱处理对水平肌加强减弱术患儿视功能、下斜肌功能和创伤恢复的影响

The influence of inferior oblique muscle weakening treatment on visual function,function of inferior oblique muscle and trauma recovery in children received horizontal muscle surgery

目的分析在水平肌加强减弱术基础上开展下斜肌减弱术治疗儿童斜视伴下斜肌功能亢进的效果。方法选择2019年12月—2021年12月本院收治的64例斜视合并下斜肌功能亢进患儿作为研究对象,随机数表法分为对照组(行水平肌加强减弱术+下斜肌后徙术)和观察组(行水平肌加强减弱术+下斜肌减弱术)两组,每组各32例。记录两组的围术期指标(术中出血量、伤口恢复时间、手术时间),记录术前和术后1个月、3个月垂直斜视角、水平斜视角;评估斜视疗效、下斜肌功能亢进疗效,记录术前和术后3个月两组视功能分级,记录并发症。结果与对照组比较,观察组术中出血量更少,伤口恢复时间更短;术后1-3个月两组垂直斜视角和水平斜视角均降低,且观察组低于对照组;观察组斜视治疗有效率(96.88%)、下斜肌功能亢进治疗有效率(93.75%)均高于对照组(71.88%、71.88%),上述比较差异均有统计学意义(P<0.05)。两组手术时间以及术前和术后3个月视功能分级比较,差异无统计学意义(P>0.05)。结论水平肌加强减弱术+下斜肌减弱术用于儿童斜视伴下斜肌功能亢进治疗中,能改善视功能,进一步提高斜视和下斜肌功能亢进疗效,创伤小,伤口恢复快,安全性高。

Objective To analyze the effect of horizontal muscle surgery combined with inferior oblique muscle weakening in the treatment of strabismus with inferior oblique muscle hyperfunction in children.Methods Atotal 64 children suffered from strabismus complicated with inferior oblique muscle hyperfunction,those were admitted to our hospital from December 2019 to December 2021,were enrolled as study subjects.They were divided into the control group(n=32,horizontal muscle surgerycombined with inferior oblique muscle recession)and observation group(n=32,horizontal muscle surgerycombined with lower oblique muscle weakening).Perioperative indexes(intraoperative blood loss,wound recovery time and operation time)of the two groups were recorded,and vertical angle of view and horizontal angle of view were recorded at before and 1 month and 3 months after operation.The efficacy of strabismus and inferior oblique muscle hyperfunction were evaluated.The visual function grades of the two groups were recorded before and 3 months after operation,and complications were recorded.Results Compared with the control group,the observation group had less intraoperative bleeding and shorter wound recovery time.The vertical angle of view and horizontal angle of view were decreased in both groups and 1and 3 months after operation,and the values of observation group were lower than the control group.The effective rate of strabismus in the observation group(96.88%)and inferior oblique muscle hyperfunction in the observation group(93.75%)were higher than those in the control group(71.88%and 71.88%),and the differences were statistically significant(P<0.05).There was no significant difference in the operation time and visual function classification before and 3 months after operation between the two groups(P>0.05).Conclusions The horizontal muscle surgery combined with lower oblique muscle weakening could improve the visual function and further improve the curative effect of the strabismus and the lower oblique muscle hyperfunction in children,with little trauma,quick wound recovery and high safety.