【摘要】 目的：观察外直肌超常量后徙在某些类型大角度外斜视矫正术中的应用和效果。方法：回顾性分析了我院200601/200807在外斜视矫正术中行外直肌超常量后徙的临床病例48例，其中分开过强型外斜视29例，知觉性外斜视16例，麻痹性外斜视3例。所有病例外斜视度数均>40△。手术原则是尽量在2 条肌肉上完成斜视度的矫正。分开过强型外斜视先行双外直肌超常量后徙（8.0～9.5mm），残余度数再行一眼内直肌缩短术。知觉性外斜视手术首选视力较差的斜视眼行外直肌超常量后徙（8.0～12mm）加内直肌缩短（6～8 mm），若矫正不足再行对侧眼外直肌后徙术。动眼神经不全麻痹者行麻痹眼外直肌超常量后徙（12～13mm）加内直肌大量截除(10mm)。结果：末次随访时所有患者外观良好，29例分开过强型外斜视中，23例正位，6例欠矫；16例知觉性外斜视中13例正位，2例欠矫，1例过矫；3例麻痹性外斜视中，1例正位，2例欠矫。所有欠矫或过矫均在±8～±15△，均不需要二次手术。所有病例中3例分开过强型外斜视和2例知觉性外斜视出现轻度外转不足，外转时角膜缘距外眦角约2～3mm；3例麻痹性外斜视外转不足均在3～4mm。结论：外直肌超常量后徙术对大度数的分开过强型外斜视，知觉性外斜视及麻痹性外斜视效果满意，避免了损伤过多的眼外肌，增加了外斜视矫正术的一次成功率。
【关键词】 外直肌超常量后徙；分开过强型外斜视；知觉性外斜视；麻痹性外斜视
Using of supernormal lateral rectus muscle recession in the surgery of largeangle exotropia
ChangMei Guo,WeiNong Wang,YuSheng Wang,Dan Hu
Department of Ophthalmology, Xijing Hospital, Fourth Military Medical University, Xian 710032, Shaanxi Province, China
AbstractAIM: To investigate the use and effect of supernormal lateral rectus muscle recession in the surgery of large-angle exotropia.
METHODS: The retrospective analysis included 48 cases of largeangle exotropia who were performed supernormal lateral rectus muscle recession, from January 2006 to July 2008 in our hospital, which including 29 divergence excess pattern, 16 sensory exotropia, and 3 paralytic exotropia. The angles of exotropia were all higher than 40△. The principle of surgery was to correct the exotropia as possible as on two muscles. Supernormal bilateral rectus muscle recession（8.09.5mm）were performed firstly in divergence excess exotropia, and residual exodeviation were corrected by shortening the medial rectus. Supernormal lateral rectus muscle recession (8.012mm) and medical rectus muscle shortened (68mm) were performed primarily on the selected poor vision eye in sensory exotropia, and if it was necessary lateral rectus recession on another eye was performed. Similarly, supernormal lateral rectus muscle recession (1213mm) and medical rectus muscle largely shortened (10mm) were performed on the paralyzed eye in paralytic exotropia.RESULTS: All patients got satisfactory appearance at last followup. Twentythree cases acquired alignment of the eyes, and 6 were undercorrected in 29 divergence excess exotropia. Thirteen cases acquired alignment, 1 was undercorrected, and 1 was overcorrected in 16 sensory exotropia. One case acquired alignment, 2 were undercorrected in 3 paralytic exotropia. The undercorrected or overcorrected angles were between ±8△ to ±15△. Slightly insufficient abversion was found in 3 cases of divergence excess exotropia, 2 sensory exotropias. and 3 paralytic exotropias.CONCLUSION: The supernormal lateral rectus muscle recession can avoid more intraocular muscles injuried. It has satisfactory effects for largeangle exotropia of divergence excess pattern, sensory exotropia and paralytic exotropia, and can improve the achievement ratio in the surgery of exotropia.
KEYWORDS: supernormal lateral rectus muscle recession; divergence excess exotropia; sensory exotropia; paralytic exotropia
0引言
外直肌常规后徙手术量最大为7mm，过去认为过量后徙会引起眼球外转功能障碍。近十几年来外直肌超常量后徙术成为国内眼肌专业最热门的“新技术”。但其在应用中也存在着问题，不是所有大角度外斜视患者都可以采用外直肌超常量后徙的[1]。因此我们选择了部分大角度外斜视患者采用外直肌超常量后徙术，最大量为13mm，手术效果满意，现报告如下。
1对象和方法
1.1对象
回顾性分析了我院200601/200807在外斜视矫正术中行外直肌超常量后徙的临床病例48例，男26例，女22例，年龄6～41(平均20.24)岁；其中分开过强型外斜视（斜视角看远大于看近15△以上）29例，知觉性外斜视16例，麻痹性外斜视 3例。全部病例外斜视度数均>40△。分开过强型外斜视患者双眼矫正视力均能达0.9，其中8例仅有同时视，6例有轻度融合，3例同视机检查立体视(+)。知觉性外斜视16例，1眼矫正视力≥0.8，另眼矫正视力≤0.12，麻痹性外斜视 3例。16例知觉性外斜视和3例动眼神经麻痹患者均无同时视。所有病例均为初次手术。不伴有明显的垂直斜视和眼球震颤，无AV现象。除3例麻痹性外斜视以外，眼球运动正常。
1.2方法
初诊时常规眼科检查，视力检查采用国际标准视力表，给予散瞳视网膜检影验光，记录屈光度及矫正视力。有屈光不正者所测斜视角均为戴镜斜视角。术前采用角膜映光、三棱镜遮盖法测定33cm和6m距离偏斜度，间歇性外斜视常规检查单眼遮盖 1h的斜视角。麻痹性斜视采用三棱镜映光法；手术前后做眼球运动检查；同视机检查同时知觉、融合及立体视三级视功能。手术原则是尽量在两条肌肉上完成斜视度的矫正。(1)分开过强型外斜视先行双外直肌超常量后徙（8.0～9.5mm），残余度数再行1眼内直肌缩短术。(2)知觉性外斜视手术首选视力较差的斜视眼行外直肌超常量后徙（8.0～12mm）加内直肌缩短（6～8mm），若矫正不足再行对侧眼外直肌后徙术。(3)动眼神经不全麻痹者行麻痹眼外直肌超常量后徙（12～13mm）加内直肌大量截除(10mm)。（4）对19例 6～10 岁儿童，手术在全麻下进行，其余患者均行局麻手术。29例分开过强型外斜视中，21例行双眼外直肌超常量后徙，8例行双眼外直肌超常量后徙加内直肌缩短。16例知觉性外斜视中，13例行斜视眼外直肌超常量后徙加内直肌缩短，3例加做对侧眼外直肌后徙术。3例动眼神经不全，麻痹者2例行麻痹眼外直肌超常量后徙加内直肌大量缩短，1例双眼动眼神经麻痹者行双眼外直肌超常量后徙加双眼内直肌大量缩短。随访时间2～18（平均9.1）mo。以最后一次复查时病情为疗效判定指标。
2结果
2.1眼位
眼位矫正结果评价为: 正位:包括完全正位、隐斜及斜视度≤±8△；欠矫:斜视度>8△；过矫:斜视度>+8△。末次随访时29例分开过强型外斜视中，23例正位，6例欠矫，正位率79%；16例知觉性外斜视中13例正位，2例欠矫，1例过矫，正位率81%；3例麻痹性外斜视中，1例正位，2例欠矫。所有欠矫或过矫均在±8～±15△，均不需要二次手术。
2.2眼球运动
末次随访时，分开过强型外斜视组中25例眼球运动正常，3例（10%）轻度外转不足，外转时角膜缘距外眦角2～3mm。知觉性外斜视中2例(12%)外转不足2～3mm；3例麻痹性外斜视外转不足均在3～4mm。
2.3视功能
分开过强型外斜视中术前8例有同时视，6例有轻度融合，3例同视机检查立体视(+)。术后 15例恢复双眼视，5例有立体视，其余仍无双眼同时视功能。知觉性外斜视和动眼神经麻痹性外斜视术后亦无同时视。
[1] [2] 下一页 |
