中华眼科杂志
中華眼科雜誌
중화안과잡지
Chinese Journal of Ophthalmology
2011年
9期
797-800
,共4页
韦严%亢晓丽%董凌燕%岑洁%陈奕烨%许宇
韋嚴%亢曉麗%董凌燕%岑潔%陳奕燁%許宇
위엄%항효려%동릉연%잠길%진혁엽%허우
眼肌麻痹%斜视%眼外科手术%眼球运动
眼肌痳痺%斜視%眼外科手術%眼毬運動
안기마비%사시%안외과수술%안구운동
Ophthalmoplegia%Strabismus%Ophthalmologic surgical procedures%Eye movements
目的 以眼底照相为客观定量检查方法，探讨单眼上斜肌麻痹患者斜视矫正术后眼球客观旋转状态的改变情况。方法 住院手术的40例（50只眼）单眼上斜肌麻痹的患者分别行患眼下斜肌切断术（15例15只眼）、患眼下斜肌部分切除术（15例15只眼）、患眼下斜肌切断+对侧眼下直肌后退术（10例20只眼）。于手术前和术后1、7、30、90 d行双眼眼底照相检查，使用绘图软件测量黄斑-视乳头夹角，定量记录客观旋转角度。并观察记录垂直斜视角度和眼球运动情况。同时对30例（60只眼）正常人行双眼眼底照相检查，记录眼球客观旋转角度。手术前后比较采用ANOVA即单因素重复测量资料方差分析方法，术后1、7、30、90d分别与术前比较采用平均值之间的多重比较q检验（SNK法）方法，不同术式间比较采用配对t检验方法。结果 30例正常人双眼眼底黄斑-视乳头夹角为右眼6.7°±2.5°，左眼5.9°±2.3°，双眼总和12.6°±4.3°，双眼间差异无统计学意义(t=1.29，P=0.20)。40例单眼上斜肌麻痹患者，术前双眼眼底黄斑-视乳头夹角为患眼14.3°±6.6°，对侧眼12.2°±4.8°，双眼总和26.5°±10.3°-双眼间差异无统计学意义(t=1.64，P=0.11)。上斜肌麻痹患者术前双眼总黄斑-视乳头夹角与正常人比较，差异有统计学意义。手术前后比较，双眼总黄斑-视乳头夹角术前为26.5°±10.3°-术后1、7、30及90d分别为11.7°±4.3°、11.9°±4.9°、13.5°±5.2°、15.9°±3.6°，组间比较差异有统计学意义(F =40.13-P＜0.01)。随术后时间延长眼球客观旋转角度又有逐渐增加的趋势，术后90d与术后1、7d对比差异有统计学意义。下斜肌切断手术组与下斜肌部分切除手术组相比，术眼手术前后黄斑-视乳头夹角改变量的差异无统计学意义(t =0.57,P=0.57)。患眼下斜肌切断+对侧眼下直肌减弱手术组，双眼间对比，手术前后黄斑-视乳头夹角改变量的差异无统计学意义(t=1.78，P=0.09)。结论 单眼上斜肌麻痹患者的眼底为外旋转位，并同时影响麻痹眼和非麻痹眼；减弱下斜肌或下直肌功能均可矫正眼球的外旋转状态，随时间延长，眼球的客观旋转角度有回退的趋势；下斜肌切断和下斜肌部分切除术矫正垂直旋转斜视的效果基本相同。
目的 以眼底照相為客觀定量檢查方法，探討單眼上斜肌痳痺患者斜視矯正術後眼毬客觀鏇轉狀態的改變情況。方法 住院手術的40例（50隻眼）單眼上斜肌痳痺的患者分彆行患眼下斜肌切斷術（15例15隻眼）、患眼下斜肌部分切除術（15例15隻眼）、患眼下斜肌切斷+對側眼下直肌後退術（10例20隻眼）。于手術前和術後1、7、30、90 d行雙眼眼底照相檢查，使用繪圖軟件測量黃斑-視乳頭夾角，定量記錄客觀鏇轉角度。併觀察記錄垂直斜視角度和眼毬運動情況。同時對30例（60隻眼）正常人行雙眼眼底照相檢查，記錄眼毬客觀鏇轉角度。手術前後比較採用ANOVA即單因素重複測量資料方差分析方法，術後1、7、30、90d分彆與術前比較採用平均值之間的多重比較q檢驗（SNK法）方法，不同術式間比較採用配對t檢驗方法。結果 30例正常人雙眼眼底黃斑-視乳頭夾角為右眼6.7°±2.5°，左眼5.9°±2.3°，雙眼總和12.6°±4.3°，雙眼間差異無統計學意義(t=1.29，P=0.20)。40例單眼上斜肌痳痺患者，術前雙眼眼底黃斑-視乳頭夾角為患眼14.3°±6.6°，對側眼12.2°±4.8°，雙眼總和26.5°±10.3°-雙眼間差異無統計學意義(t=1.64，P=0.11)。上斜肌痳痺患者術前雙眼總黃斑-視乳頭夾角與正常人比較，差異有統計學意義。手術前後比較，雙眼總黃斑-視乳頭夾角術前為26.5°±10.3°-術後1、7、30及90d分彆為11.7°±4.3°、11.9°±4.9°、13.5°±5.2°、15.9°±3.6°，組間比較差異有統計學意義(F =40.13-P＜0.01)。隨術後時間延長眼毬客觀鏇轉角度又有逐漸增加的趨勢，術後90d與術後1、7d對比差異有統計學意義。下斜肌切斷手術組與下斜肌部分切除手術組相比，術眼手術前後黃斑-視乳頭夾角改變量的差異無統計學意義(t =0.57,P=0.57)。患眼下斜肌切斷+對側眼下直肌減弱手術組，雙眼間對比，手術前後黃斑-視乳頭夾角改變量的差異無統計學意義(t=1.78，P=0.09)。結論 單眼上斜肌痳痺患者的眼底為外鏇轉位，併同時影響痳痺眼和非痳痺眼；減弱下斜肌或下直肌功能均可矯正眼毬的外鏇轉狀態，隨時間延長，眼毬的客觀鏇轉角度有迴退的趨勢；下斜肌切斷和下斜肌部分切除術矯正垂直鏇轉斜視的效果基本相同。
목적 이안저조상위객관정량검사방법，탐토단안상사기마비환자사시교정술후안구객관선전상태적개변정황。방법 주원수술적40례（50지안）단안상사기마비적환자분별행환안하사기절단술（15례15지안）、환안하사기부분절제술（15례15지안）、환안하사기절단+대측안하직기후퇴술（10례20지안）。우수술전화술후1、7、30、90 d행쌍안안저조상검사，사용회도연건측량황반-시유두협각，정량기록객관선전각도。병관찰기록수직사시각도화안구운동정황。동시대30례（60지안）정상인행쌍안안저조상검사，기록안구객관선전각도。수술전후비교채용ANOVA즉단인소중복측량자료방차분석방법，술후1、7、30、90d분별여술전비교채용평균치지간적다중비교q검험（SNK법）방법，불동술식간비교채용배대t검험방법。결과 30례정상인쌍안안저황반-시유두협각위우안6.7°±2.5°，좌안5.9°±2.3°，쌍안총화12.6°±4.3°，쌍안간차이무통계학의의(t=1.29，P=0.20)。40례단안상사기마비환자，술전쌍안안저황반-시유두협각위환안14.3°±6.6°，대측안12.2°±4.8°，쌍안총화26.5°±10.3°-쌍안간차이무통계학의의(t=1.64，P=0.11)。상사기마비환자술전쌍안총황반-시유두협각여정상인비교，차이유통계학의의。수술전후비교，쌍안총황반-시유두협각술전위26.5°±10.3°-술후1、7、30급90d분별위11.7°±4.3°、11.9°±4.9°、13.5°±5.2°、15.9°±3.6°，조간비교차이유통계학의의(F =40.13-P＜0.01)。수술후시간연장안구객관선전각도우유축점증가적추세，술후90d여술후1、7d대비차이유통계학의의。하사기절단수술조여하사기부분절제수술조상비，술안수술전후황반-시유두협각개변량적차이무통계학의의(t =0.57,P=0.57)。환안하사기절단+대측안하직기감약수술조，쌍안간대비，수술전후황반-시유두협각개변량적차이무통계학의의(t=1.78，P=0.09)。결론 단안상사기마비환자적안저위외선전위，병동시영향마비안화비마비안；감약하사기혹하직기공능균가교정안구적외선전상태，수시간연장，안구적객관선전각도유회퇴적추세；하사기절단화하사기부분절제술교정수직선전사시적효과기본상동。
ObjectiveTo investigate cyclotorsion changes after strabismus surgery in superior oblique palsy patients. Methods Forty patients (50 eyes) underwent myotomy of inferior oblique ( 15patients, 15 eyes), partial myectomy of inferior oblique ( 15 patients, 15 eyes) or myotomy of inferior oblique combined with inferior rectus recession on the other eye ( 10 patients, 20 eyes) for treatment of monocular superior obique palsy. Objective cyclotorsion were examined pre-operation, as well as 1, 7, 30,and 90 d post-operation with fundus photograph and quatitive measurement. Vertical deviation and ocular movement were also assessed before and after surgery. Fundus photograph were also examined in 30 normal persons (60 eyes) without strabismus. Results The fovea-to-disc angle of normal people was 6. 7° ±2. 5°in the right eye, 5.9° ±2. 3° in the left eye, and 12. 6° ±4. 3° when combined. The cyclotorsion angle was not statistically significant between two eyes(t =1.29,P =0. 20). For the monocular superior oblique palsy patients, preoperative fovea-to-disc angle was 14. 3° +6. 6° in the affected eyes, 12. 2° +4. 8° in the fellow eyes, and 26. 5° + 10. 3° when combined. The objective cyclotorsion was also not statistically significant between two eyes(t =1.64, P =0. 11 ). The comparision of total cyclotorsion angle of both eyes showed significant difference between normal people and patients. The fovea-to-disc angle of 1,7, 30 and 90 d after operation were 11.7 ° ± 4. 3°, 11.9° ± 4. 9°, 13. 5 ° ± 5.2 ° and 15.9° ± 3.6° respectively. The comparision of objective ocular cyclotorsion for both eyes showed significant difference pre-and post-operation (F =40. 13, P ＜ 0. 01 ). There is a gradual increasing trend of postoperative excyclotorsion angle with the prolonged time. There were statistically significant difference between 90 d and 1 d, 7 d after surgery. The two inferior oblique weakening procedures, myotomy of inferior oblique and partial myectomy of inferior oblique produced equitable amount of incyclotorsion shift with no statistical difference. The difference between the cyclotorsion change induced by myotomy of inferior oblique and inferior rectus recession in counter side was also not statistically significant. Conclusions Monocular superior oblique palsy patients had fundus excyclotorsion change that was nearly equally distributed between two eyes. Weakening the inferior oblique and inferior rectus could correct ocular excyclotorsion, the regression trend was observed 90 d after surgery. Both myotomy and partial myectomy of inferior oblique were equally effective in the correct of ocular cvclotorsion and vertical deviation.
