不同术式治疗儿童基本型或假性外展过强型间歇性外斜视的临床对照研究

A clinical comparative study of different surgical methods for the treatment of intermittent exotropia in children with basic or pseudo-abductive strabismus

摘要:

目的 探讨双眼外直肌后徙术与单眼一退一截术治疗儿童基本型或假性外展过强型间歇性外斜视的临床效果。方法 选取2016年2月—2018年4月青岛妇女儿童医院接受手术治疗的基本型或假性外展过强型间歇性外斜视儿童90例为研究对象。其中，40例行双眼外直肌后徙术治疗（BLR-rec组）；50例单眼一退一截术治疗（RR组）。比较两组患者术后1?d，以及1、6、12和24个月时的手术成功情况、斜视度，观察两组患者术后24个月时不同斜视度范围内手术病例成功情况。记录两组患者术后外斜漂移发生的情况。结果 两组患者术后1?d，以及1、6、12和24个月时手术成功率无差异（P?>0.05），但从术后1个月开始随着时间的推移，两组成功率呈下降趋势（P?<0.05）。在6?m眼位下，不同时间点两组患者斜视度有差异（P?<0.05），BLR-rec组与RR组斜视度无差异（P?>0.05），两组斜视度随时间变化的趋势有差异（P?<0.05）；在33?cm眼位下，不同 时间点两组患者斜视度有差异（P?<0.05），BLR-rec组与RR组斜视度无差异（P?>0.05），两组斜视度随时间 变化的趋势有差异（P?<0.05）；两组患者术后24个月时不同斜视度范围内手术成功率无差异（P?>0.05）；两组 患者最大外斜漂移发生于术后1?d至1个月，RR组术后1?d至1个月的外斜漂移量为（5.3±4.2），BLR-rec组 为（5.2±4.0），差异无统计学意义（P?>0.05）；但术后1?d至12个月内RR组外斜漂移量为（12.4±3.7），BLR- rec组为（7.4±3.1），差异有统计学意义（P?<0.05），RR组高于BLR-rec组。结论 采用RR或BLR-rec 2种 手术方式治疗外斜视有着一致的远期手术成功率，随着时间的延长，成功率会下降，单眼一退一截术治疗的外协漂移发生率更高，双眼外直肌后徙术的远期疗效要优于单眼一退一截术。

Abstract:

Objective To evaluate the clinical effects of binocular rectus recession (BLR-rec) and monocular retraction resection (RR) in the treatment of intermittent exotropia (IXT) with primary or pseudo-abductive exotropia in children. Methods From February 2016 to April 2018, 90 children with primary or pseudo-abductive exotropia who underwent surgical treatment were selected as subjects. Among them, 40 cases were treated with bilateral rectus recession (BLR-rec) group. Fifty cases were treated with one-eye retraction and one amputation as RR group. The surgical success and strabismus were compared between the two groups at 1 day, 1 month, 6 months, 12 months and 24 months after operation. And two groups at 24 months after surgery in different strabismus range of successful cases and the occurrence of postoperative exotropia in the two groups were recorded. Results There was no significant difference in the success rate between the two groups at 1 day, 1 month, 6 months, 12 months and 24 months after operation (P?>?0.05), but from one month after operation, the success rate of the two groups showed a decreasing trend with the passage of time (P??0.05); under 33?cm eye position, there was a difference in strabismus between the two groups at different time points (P?< 0.05); there was no significant difference between blr-rec group and RR group (P?>?0.05); there was a difference between the two groups in the trend of squint with time (P??0.05). The maximum external oblique drift occurred within 1?d to 1 month after surgery in the two groups. The amount of external oblique drift was (5.3?±?4.2) in the RR group and (5.2?±?4.0) in the r-rec group, and there was no significant difference between the two groups (P?>?0.05). However, the external oblique drift in the RR group was (12.4?±?3.7) higher than (7.4?±?3.1) in the r-rec group within 1?d to 12 months after surgery, and the difference was statistically significant (P?