CAJ | 학술논문

目的探讨下斜肌前转位治疗伴有或不伴有下斜肌功能过强的分离性垂直偏斜(DVD)的手术疗效.方法临床病对比研究.对2008年6月至2012年6月在邢台市眼科医院斜视与小儿眼科住院的43例(83只眼)DVD患者行下斜肌前转位并进行回顾性分析.将不伴有下斜肌功能过强的DVD患者22例(42只跟)为A组,伴有下斜肌功能过强的DVD患者21例(41只眼)为B组.术中对DVD眼行下斜肌前转位至下直肌附着点颞侧1 mm、前1 mm.分别观察手术前后DVD的度数、下斜肌的功能.结果术后随访时间6～12个月,平均(7.4±4.2)个月.观察手术前后DVD的度数(0～30)△、下斜肌的功能(-1～+4).术后A组(3.3±2.4)△,术后B组(3.7±2.3)△,A组和B组的手术矫正度数经统计学分析差异无统计学意义(t =1.65,P＞0.05);术前有45只眼DVD的度数＞15△(其中A组19只眼,B组26只眼),术后仍有6只眼DVD＞5△;A组2只眼术前下斜肌功能正常,B组1只眼术前下斜肌功能+1,术后下斜肌功能均为-1,术后随访下斜肌功能均正常;A组2例和B组1例单眼DVD术后出现内上转轻度受限,对侧眼出现DVD.结论 (1)下斜肌前转位对伴有或不伴有下斜肌功能过强的DVD均有效,但是对于DVD大于15△需另行其它手术方式.(2)单眼下斜肌前转位术后常出现内上转受限,手术时应慎重.
목적 탐토하사기전전위치료반유혹불반유하사기공능과강적분리성수직편사(DVD)적수술료효.방법 림상병대비연구.대2008년6월지2012년6월재형태시안과의원사시여소인안과주원적43례(83지안)DVD환자행하사기전전위병진행회고성분석.장불반유하사기공능과강적DVD환자22례(42지근)위A조,반유하사기공능과강적DVD환자21례(41지안)위B조.술중대DVD안행하사기전전위지하직기부착점섭측1 mm、전1 mm.분별관찰수술전후DVD적도수、하사기적공능.결과 술후수방시간6～12개월,평균(7.4±4.2)개월.관찰수술전후DVD적도수(0～30)△、하사기적공능(-1～+4).술후A조(3.3±2.4)△,술후B조(3.7±2.3)△,A조화B조적수술교정도수경통계학분석차이무통계학의의(t =1.65,P＞0.05);술전유45지안DVD적도수＞15△(기중A조19지안,B조26지안),술후잉유6지안DVD＞5△;A조2지안술전하사기공능정상,B조1지안술전하사기공능+1,술후하사기공능균위-1,술후수방하사기공능균정상;A조2례화B조1례단안DVD술후출현내상전경도수한,대측안출현DVD.결론 (1)하사기전전위대반유혹불반유하사기공능과강적DVD균유효,단시대우DVD대우15△수령행기타수술방식.(2)단안하사기전전위술후상출현내상전수한,수술시응신중.
Objective To evaluate the correction of anterior transposition of the inferior oblique (IO) muscle to treatment for Dissociated Vertical Deviation (DVD) with or without inferior oblique overaction.Methods A retrospective study was carried on 43 patients (83 eyes) with anterior transposition of the IO muscle to treat for DVD were admitted to the hospital from June of 2008 to June of 2012.Twenty-two cases (42 eyes) without IO overaction were group A,21 cases (41 eyes) with oblique overaction were group B.Placing the IO 1 mm ahead and 1 temporal edge of the insertion of the Inferior Retcus (IR).The amount of DVD and IR overaction before and after the operation was measured and analyzed.Results The follow-up time was 6 and 12 months,average 7.4± 4.2 months.The amount of DVD (0～30△) in primary position and the function of IO (-1 ～+4) were recorded and evaluated.after operation was the(3.3±2.4)△.The vertical deviation degree in after operation was the (3.7±2.3)△.There were not significant statistically differences between two groups (t =1.65,P ＞0.05).Forty-five had DVD of more than 15△ (19 eyes from group A and 26 eyes from group B) in which 6 eyes the residual DVD after surgery was more than 5A.Normal IR function under group A 2 cases and +1 function under group B 1 case of preoperative and postoperative function-1,However,postoperative follow-up IR were normal.Group A had 2 eyes and group B had 1 eye appeared a mild limitation of Adduction and upgaze was produced in a unilateral operation.Conclusions Anterior transposition of the IR is an effective method for correcting DVD with and without IR overaction,but more than 15△ other operation method separately.The mild limitation of adduction and upgaze is produced in a unilateral operation,therefore before the operation should be carefully evaluated.