A型肉毒毒素治疗儿童间歇性外斜视的临床观察

目的 观察A型肉毒毒素(BTXA)治疗儿童间歇性外斜视的临床疗效.方法 采用前瞻性非随机对照临床试验,将60例年龄于4～12岁的间歇性外斜视患儿分为2组,分别接受常规手术治疗(双外直肌后退或外直肌后退联合内直肌缩短术)和BTXA双外直肌注射治疗.治疗6个月后比较两组患儿的眼位矫正情况及双眼视觉功能改善情况.两组之间年龄分布及治疗前斜视度数分布比较采用两独立样本t检验和秩合检验.两组之间正位率比较采用四格表卡方检验.结果 注射组患儿治疗前平均斜视度数(-41.33±12.17)△,注射6个月后平均斜视度数(-6.23±9.80)△,7例低矫,正位率为76.67%.手术组患儿治疗前平均斜视度数(-42.83±11.72)△,手术6个月后平均斜视度数为(2.67±5.21)△,1例低矫,2例过矫,正位率为90.00%.两组患儿的治疗后眼位比较差异无统计学意义(P=0.177).两组患儿正位率的差异无统计学意义(x2=0.42,P=0.166).治疗后两组均有患儿重建了融合功能,获得了远立体视觉,近立体视觉也得到明显改善.结论 BTXA注射作为一种简便、创伤性小的治疗方式,其临床疗效可能接近手术治疗.

Observation of botulinum toxin A management in childhood with intermittent exotropia

Objective To observe the effeet of botulium toxin A(BTXA) management in childhood with intermittent extropia. Methods A prospective non-random clinical study was performed in 60 children aged from 4 to 12 years, who diagnosed to be intermittent exotropia. Patients were divided into surgery groups and BTXA group according to the intention of patients parent. The recession of bilateral rectus muscle was performed in 30 patients in surgery group. BTXA injection into bilateral rectus muscle was performed in 30 patients in BTXA group. Eye alignment and the binocular vision were evaluated 6 months after the treatments. Results In BTXA group, the deviation was (- 41.33±12.17)△(-30△ to - 75△) at the baseline, and (6.23±9.80) △ (-30△ to 0△)6 month after BTXA injection. Among the patients, 7 cases were under-correct. In surgery group ,the deviation was (-42.83±11.72)△ (-25△ to - 80△) at the baseline, and (2.67±5.21)△ (-15△ to + 15△)6 months after surgery. Among these patients, 1 case was under-corrected, and 2 cases were overcorrected. The recovery rate was 76.67% and 90.00% respectively in BTXA and surgery group, and was no statistically significant difference these two groups(P =0.177)and the covery rate(X2 =0.42,P =0.166). Some patients were found to have fusion and distance stereopsis re-built, while some others were found to have near stereopsis improvement in beth groups. Conclusion BTXA injection is a rapid, less invasive and effective procedure for the intermittent exotropia.