上斜肌劈开延长术治疗A型斜视临床疗效

目的探讨上斜肌劈开延长术治疗A型斜视的临床疗效。方法回顾性系例病例研究。收集A型斜视患者7例，均行双眼上斜肌劈开延长术联合水平斜视矫正术。随访4～10个月。手术前后分别测量患者第一眼位水平斜视度、A征程度、眼底旋转程度。上斜肌亢进分级为+1～+4。采用Wilcoxon秩和检验对数据进行分析。结果7例患者均一次手术矫正至正位，水平斜视度在±10△之内。A征均治愈。上斜肌亢进程度由术前平均+2改善至术后平均0；眼底照相结果显示，由术前平均内旋2.5°，改善至术后平均外旋2.0°，没有患者表现为主观外旋。2例术前有代偿头位的患者，术后代偿头位消失。患者术前均无垂直斜视，术后亦未出现垂直斜视。结论上斜肌劈开延长术可有效改善A型斜视和上斜肌亢进，是一种安全、有效的上斜肌减弱方法。

Efficacy of superior oblique split tendon lengthening for A-pattern strabismus

ObjectiveTo describe the results using split tendon superior oblique elongation with horizontal rectus muscle surgery for A-pattern strabismus. MethodsSeven patients with A-pattern strabismus who underwent superior oblique split tendon elongation procedure were retrospectively reviewed. The deviation angle was measured in the primary position， and 25° up-gaze and 25° down-gaze positions pre- and postoperatively. The objective torsion was recorded with fundus photography before and after surgery. Superior oblique over-action （SOOA） was graded from +1 to +4. All patients underwent bilateral superior oblique split tendon lengthening with horizontal rectus muscle surgery. A Wilcoxon matched-pairs signed rank test was used to analyze the data. The follow-up time was from 4 to 10 months. ResultsPostoperatively， 7 patients showed good alignment in the primary position with a deviation angle less than 10 PD. All A-patterns collapsed into less than 10PD. SOOA improved from +2.71 to +0.71. Fundus photography showed 5.17° less intorsion postoperatively. No patient complained of torsional diplopia after surgery. No new vertical deviation was observed in any of the 7 patients after surgery. ConclusionSuperior oblique split tendon elongation effectively improves A-pattern and SOOA.Superior oblique split tendon lengthening is a safe and effective superior oblique weakening procedure.