A型斜视的临床表现和手术治疗

目的探讨A型斜视的病因、临床特征、手术治疗方法及疗效。方法分析自1995年1月至2003年12月1825例斜视中73例A型斜视病例的病历资料及治疗效果。所有患者依据是否伴有上斜肌功能过强、原位水平斜视及双眼视觉功能情况行上斜肌部分肌腱切除术或断腱术和/或水平直肌手术,术后随访时间6～18月,平均9月。结果A型斜视占同期斜视患者4.0%。在同期所有的A-V征中,A-外斜占21.2%,A-内斜占3.8%;术后眼位恢复正位62例（84.9%）,A征消失66例（90.4%）,术后58例获得立体视功能（包括术前3例存在立体视功能患者）。结论A型斜视是一种较常见的斜视类型,发病原因以斜肌功能异常为主,常合并水平斜视,应依据是否伴有斜肌功能异常及双眼视情况,选择不同的手术方式,可获得满意的术后效果。

Clinical characteristics and surgical management in A-pattern deviation

Objective To survey the pathogenesis, clinical characteristics and surgical treatment for the correction of A-pattern deviation. Methods To analysis the case history and surgical effect of 73 A-pattern deviation in 1825 strabismus during January, 1995 to December, 2003. The superior oblique muscles weakening or the horizontal muscles procedures were performed in all patients according to the dysfunction of the superior muscles, horizontal deviation, with or without binocular vision. Follow-up after surgery is 6-18 months with mean duration of 9 months. Results A-pattern deviation accounts for 4.0% of all strabismus. A-pattern exotropia accounts for 21.2% of A-V syndrome and A-pattern esotropia is 3.8% of them. After surgery, 62 cases got alignment, 66 cases got A-sign correction and 58 cases got binocular vision. Conclusions A-pattern deviation is a common type in strabismus, its etiology is mainly oblique muscle dysfunction. Different surgical procedures should be selected according to overaction degrees of oblique muscle and binocular vision, which can acquire the satisfied results.