外直肌倾斜后徙术与外直肌后徙术治疗集合不足型外斜视的效果比较

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目的::观察外直肌倾斜后徙术(S-LR)与外直肌后徙术(LR)对集合不足型外斜视[CIX(T)]患者的治疗效果。方法::回顾性研究。收集2017年1月至2019年8月于上海交通大学医学院附属新华医院由同一术者施行的斜视矫正术的CIX(T)患者101例,根据术式分为双眼外直肌倾斜后徙术(S-BLR)组44例和双眼外直肌后徙术(BLR)组57例,随访3个月,观察比较行不同术式的患者术后视近斜视角、视远斜视角及远近斜视角度差(NDD)。使用Mann-Whitney n U检验、卡方检验、n t检验等进行统计学分析。n 结果::术后3个月,NDD较术前的改善量在S-BLR组和BLR组分别为(8.0±3.3)棱镜度(PD)和(6.1±4.0)PD,S-BLR组较BLR组对NDD的改善更明显(n Z=-1.995,n P=0.046)。术后3个月,视近斜视角S-BLR组为(-5.1±5.5)PD,较BLR组的(-8.3±5.8)PD明显减小(n Z=-2.882,n P=0.004)。视远斜视角在S-BLR组与BLR组手术前后,差异无统计学意义。术后3个月正位率在S-BLR组为82%,高于BLR组的53%(n χ2=9.34,n P=0.002)。S-LR前后,S-BLR组患者上视及下视斜视角度差及黄斑中心凹-视盘中心夹角度数差异均无统计学意义。n 结论::S-LR对CIX(T)的视近斜视角及NDD疗效优于LR,是一种安全有效的术式。“,”Objective::To observe the surgical effects of slanted lateral rectus recession (S-LR) and lateral rectus recession (LR) on convergence insufficiency intermittent exotropia [CIX (T)].Methods::In this retrospective study, surgery was performed by the same surgeon on 101 patients with CIX (T) in Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2017 to August 2019. They were divided into 2 groups: A bilateral slanted lateral rectus recession group (S-BLR group, 44 cases) and a bilateral lateral rectus recession group (BLR group, 57 cases). All patients were followed up for 3 months. The postoperative near deviation, distant deviation, and near-distant disparity (NDD) were measured and compared in this retrospective study. Data were analyzed using Mann-Whitney n U test, n χ2 test, n t test.n Results::Three months after surgery, the improvement of NDD was 8.0±3.3 PD in the S-BLR group and 6.1±4.0 PD in the BLR group (n Z=-1.995, n P=0.046). NDD improved more significantly in the S-BLR group than in the BLR group. The near deviation of the S-BLR group (-5.1±5.5 PD) significantly decreased compared with the BLR group (-8.3±5.8 PD)(n Z=-2.882, n P=0.004). There was no significant difference in distant deviation between the S-BLR group and LR group after 3 months. The success rates after 3 months of follow-up were 82% in the S-BLR group, which was a higher rate than 53% in the BLR group (n χ2=9.34, n P=0.002). There was no significant difference between preoperative and postoperative fovea-disc angles and A and V patterns in the S-BLR group.n Conclusions::In postoperative near deviation and NDD, S-LR patients improve more significantly than LR patients. S-LR does not cause A and V pattern strabismus or fundus rotation. S-LR patients have a better surgical outcome than LR patients with CIX (T).
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