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目的对照研究单眼外直肌后徙内直肌缩短与双眼外直肌后徙两种手术方式对共同性外斜视的手术效果、术后并发症、双眼单视功能、复发率方面的差异。方法将2003年8月～2007年4月住院的共同性外斜视197例(均为基本型),斜视度30~Δ～60~Δ,分两组,A组行单眼外直肌后徙内直肌缩短手术,B组行双眼外直肌后徙手术。术后同视机训练1周,随诊半年,收集临床资料。结果1.术后一月眼位正位率A组89%,B组85%,差异无统计学意义(P=0.18);术后半年眼位正位率A组81%,B组67%,差异具有统计学意义(P=0.04);2.术后半年,眼球运动受限(外转欠2mm以上)及侧方复视发生率A组24%,24%,B组51%,39%,差异具有统计学意义(P=0.04);3.术后一月,建立Ⅰ、Ⅱ、Ⅲ、级视功能比例:A组63%、40%、41%,B组68%、37%、30%,差异无统计学意(P=0.12);术后半年,建立Ⅰ、Ⅱ、Ⅲ级视功能比例:A组51%、32%、32%,B组32%、21%、19%,差异具有统计学意义(P=0.02);4.复发(眼位回退>- 10°)率:A组16%,B组34%。差异具有统计学意义(P=0.04)。结论两种手术方式对矫正共同性外斜视各有优缺点,采用单眼外直肌后徙内直肌缩短手术的远期效果要好于双眼外直肌后徙术。
Objective To compare the surgical effects, postoperative complications, binocular vision, recurrence rate of two methods of shortening rectus abdominis retraction and rectus abdominis posterior foraminotomy in monocular rectus muscle. Methods From July 2003 to April 2007, 197 cases of common exotropia (all basic type) were hospitalized. The strabismus was 30 ~ 60 ~ Δ, divided into two groups. Rectus muscle shortening operation, B group line bilateral rectus muscle reimplantation surgery. With the same machine training after 1 week, followed up for six months, collecting clinical data. The positive rate of eye position in one month after surgery was 89% in group A and 85% in group B, with no significant difference (P = 0.18) , The difference was statistically significant (P = 0.04); 2. 6 months after surgery, eye movement limited (outside the transfer less than 2mm) and the incidence of lateral diplopia in group A 24%, 24%, B 51%, 39 %, The difference was statistically significant (P = 0.04); 3 month after the establishment of Ⅰ, Ⅱ, Ⅲ grade visual function ratio: A group of 63%, 40%, 41%, B group 68%, 37% , 30% respectively, with no significant difference (P = 0.12). Six months after operation, the visual acuity of grade Ⅰ, Ⅱ and Ⅲ were 51%, 32%, 32% in group A, 32%, 21% %, Respectively. The difference was statistically significant (P = 0.02) .4. The recurrence rate was 16% in group A and 34% in group B, respectively. The difference was statistically significant (P = 0.04). Conclusion Both methods of operation have the advantages and disadvantages of correction of common exotropia. The long-term effect of shortening surgery of rectus rectus by monocular rectus muscle is better than that of rectus abdominis muscle.