CAJ | 학술논문

目的探讨共同性水平斜视手术后施行再次斜视手术的临床特点及手术处理的特殊性.方法共同性水平斜视手术后施行再次斜视手术的55例患者进行了回顾性临床分析,手术前后进行眼位检查、眼球运动,Titmus立体视检查双眼视觉功能.手术方法:手术前做全麻下或局麻下行牵拉试验.手术方式选择原则:依据视近和视远斜视角的不同,眼球运动受限制的受累肌肉和牵拉试验结果选择术式.术后追踪观察1～8年,平均2年.结果 (1)内斜视术后继发外斜视13例中,除即刻过矫3例在手术后48h内施行内直肌探查术外,其余施行原后徙内直肌完全复位或部分复位术,联合外直肌截除.治愈率76.9%.外斜视术后继发内斜视11例,施行原后徙外直肌完全复位或部分复位术,联合内直肌截除.治愈率81.8%.伴有V型斜视和垂直性斜视者联合水平直肌移位或斜肌减弱术.(2)内斜视欠矫15例中,8例施行内直肌边缘切开联合外直肌截除术;选择单纯在同一眼上外直肌截除术2例;伴有斜肌异常患者,则选择对侧眼内直肌后徙联合外直肌截除并下斜肌后徙5例.术后正位率86.7%.外斜视欠矫16例中:6例施行原外直肌后徙眼边缘切开联合内直肌截除术;2例Ⅴ型外斜视联合双下斜肌后徙,4例外直肌周围瘢痕松解术,4例联合调整缝线.术后正位率87.5%.结论 (1)水平斜视过矫伴有受累肌运动障碍,结合看近与看远斜视角的差别,选择内直肌或外直肌复位术.(2)调整术后缝线可将再次斜视手术的非预期结果降低到最小程度.
목적 탐토공동성수평사시수술후시행재차사시수술적림상특점급수술처리적특수성.방법 공동성수평사시수술후시행재차사시수술적55례환자진행료회고성림상분석,수술전후진행안위검사、안구운동,Titmus입체시검사쌍안시각공능.수술방법:수술전주전마하혹국마하행견랍시험.수술방식선택원칙:의거시근화시원사시각적불동,안구운동수한제적수루기육화견랍시험결과선택술식.술후추종관찰1～8년,평균2년.결과 (1)내사시술후계발외사시13례중,제즉각과교3례재수술후48h내시행내직기탐사술외,기여시행원후사내직기완전복위혹부분복위술,연합외직기절제.치유솔76.9%.외사시술후계발내사시11례,시행원후사외직기완전복위혹부분복위술,연합내직기절제.치유솔81.8%.반유V형사시화수직성사시자연합수평직기이위혹사기감약술.(2)내사시흠교15례중,8례시행내직기변연절개연합외직기절제술;선택단순재동일안상외직기절제술2례;반유사기이상환자,칙선택대측안내직기후사연합외직기절제병하사기후사5례.술후정위솔86.7%.외사시흠교16례중:6례시행원외직기후사안변연절개연합내직기절제술;2례Ⅴ형외사시연합쌍하사기후사,4예외직기주위반흔송해술,4례연합조정봉선.술후정위솔87.5%.결론 (1)수평사시과교반유수루기운동장애,결합간근여간원사시각적차별,선택내직기혹외직기복위술.(2)조정술후봉선가장재차사시수술적비예기결과강저도최소정도.
Objective To investigate the results and techniques of surgical treatment of consecutive strabismus following concomitant horizontal strabismus surgery. Methods Fifty-five patients operated on for consecutive strabismus following their first surgical treatment of concomitant horizontal deviation were analyzed retrospectively. Preoperative visual acuity, deviation, mobility evaluation, stereoacuity with Titmus test and traction test were performed as well as post-operative residual deviation and binocular function. The mean postoperative follow-up time was 2years. Results Thirteen patients with consecutive exotropia due to overcorrection for primary concomitant esotropia were managed with exploratory operation (3 patients) or treated with unilateral lateral rectus muscle recession combined with medial rectus muscle advancement (10 patients),in which 10 patients (76.9%) achieved satisfactory alignment at final follow-up. Eleven patients with consecutive esotropia due to overcorrection for primary concomitant exotropia underwent medial rectus muscle resection and lateral rectus muscle complete of partial advancement to the original insertion and 9 patients in which achieved long-term satisfactory alignment. Fifteen patients with undercorrection for concomitant esotropia were treated with medial rectus marginal myotomy combined with lateral rectus muscle recession (8 patients), unilateral lateral rectus muscle recession (2 patients) or medial rectus recession and lateral rectus resection combined with inferior oblique muscle recession in fellow eye (5 patients with Oblique muscle abnormal), and postoperative orthophoria rate was 86.7%. Sixteen patients with undercorrection for concomitant exotropia were treated with lateral rectus muscle recession and medial rectus muscle resection (6 patients) or combined with inferior oblique muscle recession (2 patients with V-exotropia), cicatricotomy for lateral rectus muscle (4 patients) or adjusted of releasable sutures (4 patients), in which postoperative orthophoria rate was 87.5%. Conclusions The reversal of unilateral medial rectus and lateral rectus recession or resection is an effective alternative for treating postoperative consecutive exotropia due to overcorrection of concomitant horizontal strabismus. Adjusting of releasable sutures provide more stable expections of the results achieved by the re-operation.