單側(cè)與雙側(cè)內(nèi)直肌后徙術(shù)治療兒童集合過強(qiáng)型內(nèi)斜視的療效比較
發(fā)布時(shí)間：2018-08-09 20:06
【摘要】：研究背景和目的：集合過強(qiáng)型內(nèi)斜視的臨床表現(xiàn)為戴鏡看近的斜視度比戴鏡看遠(yuǎn)的斜視度≥10PD。集合過強(qiáng)型內(nèi)斜視經(jīng)梯度法檢測后可被分為以下3種類型：(1)屈光性調(diào)節(jié)性內(nèi)斜視伴有高AC/A；(2)非屈光性調(diào)節(jié)性內(nèi)斜視伴有高AC/A；(3)非調(diào)節(jié)性集合過強(qiáng)型內(nèi)斜視。其中伴有高AC/A的屈光性調(diào)節(jié)性內(nèi)斜視比較常見,后2種類型臨床相對少見。對于伴有高AC/A的集合過強(qiáng)型內(nèi)斜視,臨床上常采用戴雙焦點(diǎn)眼鏡治療,但患兒看遠(yuǎn)也存在斜視或戴雙焦點(diǎn)眼鏡看近仍有明顯內(nèi)斜視時(shí),則需手術(shù)治療。而非調(diào)節(jié)性集合過強(qiáng)型內(nèi)斜視的唯一治療方法為斜視矯正術(shù)。雙側(cè)內(nèi)直肌后徙術(shù)因操作相對簡單,療效確切、術(shù)后并發(fā)癥少被公認(rèn)為治療集合過強(qiáng)型內(nèi)斜視的常用術(shù)式。近年來有文獻(xiàn)報(bào)道采用單側(cè)內(nèi)直肌后徙術(shù)亦可有效的矯正中小度數(shù)的集合過強(qiáng)型內(nèi)斜視。本文旨在比較單側(cè)內(nèi)直肌后徙與雙側(cè)內(nèi)直肌后徙術(shù)治療兒童集合過強(qiáng)型內(nèi)斜視的療效。 方法：回顧性系列病例研究。收集2009年7月至2013年3月在山東大學(xué)附屬省立醫(yī)院行單側(cè)內(nèi)直肌后徙與雙側(cè)內(nèi)直肌后徙術(shù)治療、并符合納入標(biāo)準(zhǔn)的集合過強(qiáng)型內(nèi)斜視患兒共66例,均按照戴鏡看近斜視度設(shè)計(jì)手術(shù)量,行單側(cè)內(nèi)直肌后徙29例、雙側(cè)內(nèi)直肌后徙37例。療效評價(jià)標(biāo)準(zhǔn)為看遠(yuǎn)和看近斜視度(0~+9)PD為正位。采用x2檢驗(yàn)對兩組手術(shù)后正位率、欠矯率及過矯率進(jìn)行統(tǒng)計(jì)比較；采用配對t檢驗(yàn)比較手術(shù)前后看近與看遠(yuǎn)斜視度差值(N-D)的差異,采用獨(dú)立樣本t檢驗(yàn)比較兩組術(shù)后看近斜視度、看遠(yuǎn)斜視度、N-D及手術(shù)前后N-D變化值的差異。 結(jié)果：術(shù)后遠(yuǎn)期(11.62±8.21月)隨訪,兩組正位率、欠矯率及過矯率的差異均無統(tǒng)計(jì)學(xué)意義(P0.05)；兩組看近斜視度(P=0.253)、看遠(yuǎn)斜視度(P=0.140)的差異均無統(tǒng)計(jì)學(xué)意義；單側(cè)內(nèi)直肌后徙組的N-D術(shù)前為(15.21±4.29)PD,術(shù)后為(3.93±5.61)PD,手術(shù)前后N-D的差異有統(tǒng)計(jì)學(xué)意義(P=0.000)；雙側(cè)內(nèi)直肌后徙組的N-D術(shù)前為(15.37±4.69)PD,術(shù)后為(3.84±4.77)PD,手術(shù)前后N-D的差異有統(tǒng)計(jì)學(xué)意義(P=0.000)。兩組術(shù)后N-D的差異無統(tǒng)計(jì)學(xué)意義(P=0.322)；手術(shù)前后N-D的變化值單側(cè)內(nèi)直肌后徙組為(11.28±7.00)PD,雙側(cè)內(nèi)直肌后徙組為(11.54±5.82)PD,兩組差異無統(tǒng)計(jì)學(xué)意義(P=0.249)。術(shù)后正位的44例患兒中,30例患兒能配合雙眼單視功能檢查,其中22例(73.3%)獲得了周邊融合(4例同時(shí)獲得了中心融合)；16例(53.3%)獲得了不同程度的近立體視覺(3000-400"),4例獲得了精細(xì)立體視覺(40”)。 結(jié)論：按照戴鏡看近斜視度設(shè)計(jì)手術(shù),單側(cè)內(nèi)直肌后徙術(shù)治療兒童中、小度數(shù)集合過強(qiáng)型內(nèi)斜視與雙側(cè)內(nèi)直肌后徙術(shù)治療兒童中、大度數(shù)集合過強(qiáng)型內(nèi)斜視的療效相同,兩種術(shù)式均能有效的減小看近與看遠(yuǎn)斜視度的差值。
[Abstract]:Background and objective: the clinical manifestation of overstrong esotropia is that the degree of strabismus is greater than 10 PD. There are three types of intensive esotropia: (1) accommodative esotropia with high AC / A; (2) non-refraction accommodative esotropia with high AC / A; (3) unadjustable set with overstrong esotropia. Refractive accommodative esotropia with high AC/A is common, and the latter two types are relatively rare. For the patients with high AC/A, the patients with intensive esotropia are often treated with binocentric glasses, but there is strabismus or esotropia with binocentric glasses. The only treatment for non-accommodative intensive esotropia is strabismus correction. Bilateral medial rectus recession is relatively simple and effective, and postoperative complications are rarely recognized as common methods for the treatment of intensive esotropia. In recent years, it has been reported that unilateral medial rectus recession can also be used to correct the over-intensive esotropia. The purpose of this study was to compare the efficacy of unilateral medial rectus recession and bilateral medial rectus recession in the treatment of intensive esotropia in children. Methods: a series of retrospective case studies. From July 2009 to March 2013, 66 patients with unilateral rectus and bilateral rectus were treated in the provincial hospital affiliated to Shandong University. All patients were treated with unilateral medial rectus and bilateral medial rectus in 29 cases and bilateral rectus muscle in 37 cases. The criteria for evaluation of curative effect were (0 ~ 9) PD and (0 ~ 9) PD were positive. The positive position rate, undercorrection rate and overcorrection rate after operation were statistically compared between the two groups by using x2 test, and the difference between near and far strabismus (N-D) before and after operation was compared by paired t test. The difference of the degree of near strabismus, the degree of far strabismus and the changes of N-D before and after operation were compared between the two groups by independent t-test. Results: there was no significant difference in the positive position rate, undercorrection rate and overcorrection rate between the two groups (P 0.05), but there was no significant difference between the two groups in the near strabismus (P < 0. 253) and the distance strabismus (P < 0. 140), in the long term postoperative follow-up (11. 62 鹵8. 21 months), there was no significant difference between the two groups in the positive position rate, the undercorrection rate and the overcorrection rate (P 0. 05). The N-D of unilateral rectus group was (15.21 鹵4.29) PDbefore and (3.93 鹵5.61) PD. the difference of N-D before and after operation was statistically significant (P0. 000), the N-D of bilateral medial rectus recession group was (15. 37 鹵4. 69) PDbefore operation and (3. 84 鹵4. 77) PD. the difference before and after operation was statistically significant (P0. 000). There was no significant difference in N-D between the two groups before and after operation (P < 0.322), but the change of N-D in unilateral rectus group was (11.28 鹵7.00) PDand that in bilateral rectus group was (11.54 鹵5.82) PD.There was no significant difference between the two groups (P < 0.249). 30 of 44 postoperatively orthostatic children were able to cooperate with binocular monocular function examination, of which 22 (73.3%) obtained peripheral fusion (4 cases obtained central fusion). 16 cases (53.3%) obtained different degrees of near stereo vision (3000-400 ") and 4 cases got fine stereo vision (40"). Conclusion: in the design of surgery according to the degree of proximal strabismus and unilateral rectus recession in the treatment of children, in the treatment of children with small degrees of overstrong esotropia and bilateral rectus, the curative effect of large degree collection of excessive esotropia is the same as that of bilateral internal rectus recession. Both methods can effectively reduce the difference between near and far strabismus.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R777.41
本文編號(hào)：2175171
[Abstract]:Background and objective: the clinical manifestation of overstrong esotropia is that the degree of strabismus is greater than 10 PD. There are three types of intensive esotropia: (1) accommodative esotropia with high AC / A; (2) non-refraction accommodative esotropia with high AC / A; (3) unadjustable set with overstrong esotropia. Refractive accommodative esotropia with high AC/A is common, and the latter two types are relatively rare. For the patients with high AC/A, the patients with intensive esotropia are often treated with binocentric glasses, but there is strabismus or esotropia with binocentric glasses. The only treatment for non-accommodative intensive esotropia is strabismus correction. Bilateral medial rectus recession is relatively simple and effective, and postoperative complications are rarely recognized as common methods for the treatment of intensive esotropia. In recent years, it has been reported that unilateral medial rectus recession can also be used to correct the over-intensive esotropia. The purpose of this study was to compare the efficacy of unilateral medial rectus recession and bilateral medial rectus recession in the treatment of intensive esotropia in children. Methods: a series of retrospective case studies. From July 2009 to March 2013, 66 patients with unilateral rectus and bilateral rectus were treated in the provincial hospital affiliated to Shandong University. All patients were treated with unilateral medial rectus and bilateral medial rectus in 29 cases and bilateral rectus muscle in 37 cases. The criteria for evaluation of curative effect were (0 ~ 9) PD and (0 ~ 9) PD were positive. The positive position rate, undercorrection rate and overcorrection rate after operation were statistically compared between the two groups by using x2 test, and the difference between near and far strabismus (N-D) before and after operation was compared by paired t test. The difference of the degree of near strabismus, the degree of far strabismus and the changes of N-D before and after operation were compared between the two groups by independent t-test. Results: there was no significant difference in the positive position rate, undercorrection rate and overcorrection rate between the two groups (P 0.05), but there was no significant difference between the two groups in the near strabismus (P < 0. 253) and the distance strabismus (P < 0. 140), in the long term postoperative follow-up (11. 62 鹵8. 21 months), there was no significant difference between the two groups in the positive position rate, the undercorrection rate and the overcorrection rate (P 0. 05). The N-D of unilateral rectus group was (15.21 鹵4.29) PDbefore and (3.93 鹵5.61) PD. the difference of N-D before and after operation was statistically significant (P0. 000), the N-D of bilateral medial rectus recession group was (15. 37 鹵4. 69) PDbefore operation and (3. 84 鹵4. 77) PD. the difference before and after operation was statistically significant (P0. 000). There was no significant difference in N-D between the two groups before and after operation (P < 0.322), but the change of N-D in unilateral rectus group was (11.28 鹵7.00) PDand that in bilateral rectus group was (11.54 鹵5.82) PD.There was no significant difference between the two groups (P < 0.249). 30 of 44 postoperatively orthostatic children were able to cooperate with binocular monocular function examination, of which 22 (73.3%) obtained peripheral fusion (4 cases obtained central fusion). 16 cases (53.3%) obtained different degrees of near stereo vision (3000-400 ") and 4 cases got fine stereo vision (40"). Conclusion: in the design of surgery according to the degree of proximal strabismus and unilateral rectus recession in the treatment of children, in the treatment of children with small degrees of overstrong esotropia and bilateral rectus, the curative effect of large degree collection of excessive esotropia is the same as that of bilateral internal rectus recession. Both methods can effectively reduce the difference between near and far strabismus.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R777.41
【參考文獻(xiàn)】
相關(guān)期刊論文 前1條
1 趙堪興;斜視矯正術(shù)設(shè)計(jì)的思考[J];中華眼科雜志;2002年08期
，本文編號(hào)：2175171
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