腹直肌折叠术后的效果：一种潜在可逆转、血管保留的替代切除术方法。
Surgical outcomes following rectus muscle plication: a potentially reversible, vessel-sparing alternative to resection.
机构信息
SteinEye Institute, University of California, Los Angeles2Department of Ophthalmology, University of California, Los Angeles.
SteinEye Institute, University of California, Los Angeles2Department of Ophthalmology, University of California, Los Angeles3Department of Neurology, University of California, Los Angeles4Neuroscience Interdepartmental Program, University of California, L.
出版信息
JAMA Ophthalmol. 2014 May;132(5):579-85. doi: 10.1001/jamaophthalmol.2013.8188.
IMPORTANCE
Extraocular muscle strengthening is a common treatment for strabismus. Plication is an alternative procedure for strengthening muscles with less tissue trauma than resection.
OBJECTIVE
To compare the surgical dose effect of plication with that of resection.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective comparison of surgical outcomes in an academic pediatric ophthalmology and strabismus practice from July 25, 2005, through March 28, 2013, with a mean follow-up of 137 days for plication and 1243 days for resection. A single surgeon performed all procedures. Twenty-two consecutive patients underwent bilateral horizontal rectus plication or plication combined with antagonist recession (13 with esotropia and 9 with exotropia; mean [SD] age, 38 [21] years). Thirty-one consecutive patients underwent bilateral resection or resection combined with antagonist recession (12 with esotropia and 19 with exotropia; mean [SD] age, 28 [24] years). Six patients underwent vertical rectus plication.
EXPOSURES
Rectus resection or plication performed by folding the anterior tendon posteriorly under the muscle margins oversewn to the poles of the scleral insertion, avoiding the anterior ciliary arteries.
MAIN OUTCOMES AND MEASURES
Postoperative binocular alignment at the first postoperative and last available examinations.
RESULTS
Lateral rectus plication (mean [SD], 6.5 [2.2] mm) and resection (6.6 [1.6] mm) were performed for similar magnitudes of esotropia (27.9 [13.4] prism diopters [PD] for plication, 29.0 [15.2] PD for resection; P = .44). Mean (SD) initial correction by lateral rectus plication was 5.17 (0.29) PD/mm, slightly less than the 95% CI (5.51-7.75 PD/mm) for resection (6.63 [0.50] PD/mm). Medial rectus plication (mean [SD], 4.9 [0.9] mm) vs resection (5.1 [1.1] mm) was performed for similar magnitudes of exotropia (32.8 [14.2] PD for plication, 31.2 [15.6] PD for resection; P = .33). Mean (SD) initial correction by medial rectus plication (7.10 [1.65] PD/mm) was within the 95% CI (4.65-9.87 PD/mm) for resection (7.26 [1.23] PD/mm). Initial and late effects were similar. Ciliary circulation observed at surgery remained patent after plication. Plication was cosmetically acceptable and did not produce conspicuous tissue elevations.
CONCLUSIONS AND RELEVANCE
Horizontal rectus muscle plication is a rapidly performed, technically simple surgical procedure to strengthen the rectus muscles, with an equivalent (per millimeter) in surgical effect to that of medial rectus resection for treatment of esotropia and exotropia. Plication diminishes surgical trauma and does not intentionally sacrifice ciliary circulation, with the potential for reversal by suture release in the first postoperative days.
重要性
眼外肌加强是斜视的常见治疗方法。比起切除术，肌腱折叠术是一种替代程序，它对组织的创伤较小。
目的
比较肌腱折叠术和切除术的手术剂量效果。
设计、环境和参与者：2005 年 7 月 25 日至 2013 年 3 月 28 日，在一家学术性小儿眼科和斜视实践中进行了回顾性比较，平均随访 137 天的折叠术和 1243 天的切除术。一位外科医生完成了所有手术。22 名连续患者接受了双侧水平直肌折叠术或折叠术联合拮抗肌后退术（13 例内斜视和 9 例外斜视；平均[SD]年龄，38[21]岁）。31 名连续患者接受了双侧切除术或切除术联合拮抗肌后退术（12 例内斜视和 19 例外斜视；平均[SD]年龄，28[24]岁）。6 名患者接受了垂直直肌折叠术。
暴露
通过在缝合的肌前肌腱后面折叠，使它位于巩膜插入的两极之间，从而绕过前睫状动脉来进行直肌切除术或折叠术。
主要结果和测量
术后第一次和最后一次可获得的检查时的双眼对准情况。
结果
外侧直肌折叠术（平均[SD]，6.5[2.2]mm）和切除术（6.6[1.6]mm）用于治疗相似程度的内斜视（折叠术为 27.9[13.4]棱镜屈光度[PD]，切除术为 29.0[15.2]PD；P=0.44）。外侧直肌折叠术的初始平均（SD）矫正值为 5.17（0.29）PD/mm，略低于切除术的 95%CI（5.51-7.75 PD/mm）（6.63[0.50]PD/mm）。内侧直肌折叠术（平均[SD]，4.9[0.9]mm）和切除术（5.1[1.1]mm）用于治疗相似程度的外斜视（折叠术为 32.8[14.2]PD，切除术为 31.2[15.6]PD；P=0.33）。内侧直肌折叠术的初始平均（SD）矫正值（7.10[1.65]PD/mm）在切除术的 95%CI（4.65-9.87 PD/mm）范围内（7.26[1.23]PD/mm）。初始和晚期效果相似。手术后观察到的睫状循环在折叠术后仍然保持通畅。折叠术是一种美容效果良好且不会产生明显组织隆起的手术，其对直肌的加强效果（每毫米）与内侧直肌切除术相当，可用于治疗内斜视和外斜视。折叠术减少了手术创伤，并不故意牺牲睫状循环，在术后最初几天通过缝线松解有逆转的可能。
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