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目的探讨两种上斜肌减弱手术即断腱术和肌腱延长术在A型斜视治疗中的作用。方法对32例上斜肌功能亢进伴A型斜视患者分别行上斜肌断腱术和肌腱延长术,并矫正水平斜视,对术前术后的眼位、A征的矫正情况、上斜肌减弱手术在上斜肌功能眼位垂直斜视矫正量、上斜肌减弱手术对第一眼位及下方水平斜视度的影响、上斜肌的功能状况和双眼单视功能等方面进行研究。结果32例中,正位27例(84.4%),内斜5例(15.6%);A征消失26例(81.3%)。术后上、下转25°时斜视度差平均6.9△;上斜肌减弱术在上斜肌功能眼位垂直斜视矫正量平均11.10±4.90°;术后上斜肌功能不足发生率断腱术高于延长术;残留上斜肌亢进发生率延长术高于断腱术;两种减弱手术对A征矫正没有明显差别(P>0.05)。双眼上斜肌减弱手术对A征矫正量平均26.94±10.39△;对下方外斜视矫正量平均23.61±10.51△;对第一眼位水平斜视影响+14△￣-11△。结论两种上斜肌减弱术矫正A型斜视伴上斜肌亢进安全有效;上斜肌减弱手术方式应根据上斜肌亢进程度、A征及双眼单视功能情况综合考虑;上斜肌腱延长术可以根据上斜肌亢进程度适当定量,针对性较好;双眼单视功能较好,上斜肌亢进程度较轻行延长术比较安全;当A征<20△时行双眼上斜肌减弱术应慎重。
Objective To investigate the effects of two kinds of upper oblique muscle weakening surgery, ie tendon and tendon extension on type A strabismus. Methods Twenty-two patients with upper oblique muscle dysfunction and type A strabismus underwent oblique tendon surgery and tendon lengthening surgery, and corrected horizontal strabismus. The correction of ocular status, A sign, Weakened the amount of vertical strabismus in the oblique position of upper oblique function, the influence of upper oblique weakening operation on the level of the first level and lower level of strabismus, the functional status of the upper oblique muscle and binocular vision function. Results Among the 32 cases, 27 cases were positive (84.4%) and 5 cases were internal oblique (15.6%). A sign disappeared in 26 cases (81.3%). The mean deviation of strabismus in the upper oblique muscle was 11.10 ± 4.90 ° on average. The incidence of upper oblique muscle dysfunction in the lower oblique was (P> 0.05). There was no significant difference between the two kinds of weakening surgery on the correction of A syndrome (P> 0.05). Binocular oblique reduction surgery on A levy correction average 26.94 ± 10.39 △; on the lower exotropia correction an average of 23.61 ± 10.51 △; on the first position horizontal strabismus + 14 △ ~ 11 △. Conclusions Both of the two types of upper oblique weakening technique are safe and effective in correcting type A strabismus with hypersympathetic hyperactivity. The treatment of upper oblique muscle weakening should be based on the degree of hyperacusis, A sign and binocular visual function, Can be based on the extent of the degree of supratemporal sarcoma appropriate quantitative, better targeted; binocular single vision function is better, the degree of lengthening of the upper oblique hypertrophy safer to extend surgery; when A sign <20 △ when the line of weakening of the upper oblique surgery should be careful.