眼球震颤/先天性,特发性%斜视%中间带移位%本体感受器切除
眼毬震顫/先天性,特髮性%斜視%中間帶移位%本體感受器切除
안구진전/선천성,특발성%사시%중간대이위%본체감수기절제
Eyeball nystagmus/congenital,Idiopathic%Strabismus%Park's surgery%Extraocular proprioception resection
背景 先天性特发性眼球震颤的手术方式已日渐成熟,但其术后视功能的恢复仍然值得关注.目的 探讨先天性特发性眼球震颤的手术治疗方法及其对视功能的影响.方法 按照患者的头位扭转角大小和斜视度数的不同将60例先天性特发性眼球震颤患者分为4组,Ⅰ组:头位扭转角＜15°,水平斜视度≤15△,行本体感受器切除术；Ⅱ组:头位扭转角＜15°,水平斜视度＞15△,行本体感受器切除术联合斜视矫正术；Ⅲ组:头位扭转角≥15°,水平斜视度≤15△,行中间带移位术(部分同时施行本体感受器切除术)；Ⅳ组:患者头位扭转角≥15°,水平斜视度＞15△,行中间带移位联合斜视矫正术(部分同时施行本体感受器切除术),采用自身对照法对患者手术前后单眼及双眼远近最佳矫正视力、头位扭转角、斜视度、眼球运动及立体视觉的变化进行比较.结果与术前相比,术后各组患者第一眼位单眼及双眼远视力均明显提高,差异均有统计学意义(单眼:t=6.00、8.94、11.76、16.41,P=0.00；双眼:t=4.81,P=0.01；t=6.27、4.25、4.18,P=0.00).术后Ⅰ组和Ⅱ组患者单眼及双眼近视力与术前比较差异无统计学意义(单眼:t=1.63,P=0.18；t=1.17,P=0.26;双眼:t=2.45,P=0.07;t=2.09,P=0.06),而Ⅲ组和Ⅳ组患者术后单眼及双眼近视力均明显提高(单眼:t=2.91,P=0.01；t=5.32,P=0.00；双眼:t=3.36、4.30,P=0.00).Ⅲ组和Ⅳ组中,术前有代偿头位的41例中,术后39例代偿头位消失,2例明显改善,头位扭转角手术前后比较差异有统计学意义(t=29.90、16.91,P=0.00).术前26例合并斜视的患者中术后24例患者眼位正位,2例患者斜视欠矫,Ⅱ组、Ⅳ组斜视度明显降低,手术前后比较差异均有统计学意义(t=29.15、36.79,P=0.00).所有患者术后眼球运动无受限.术前12岁以下的患儿共23例,立体视觉平均为256.52″±66.23″,术后1年其立体视觉平均为120.87″±45.31″,手术前后比较差异有统计学意义(t=12.06,P=0.00).结论 中间带移位术、本体感受器切除术及斜视矫正术可以改善先天性特发性眼球震颤患者的视功能、矫正头位及斜视.
揹景 先天性特髮性眼毬震顫的手術方式已日漸成熟,但其術後視功能的恢複仍然值得關註.目的 探討先天性特髮性眼毬震顫的手術治療方法及其對視功能的影響.方法 按照患者的頭位扭轉角大小和斜視度數的不同將60例先天性特髮性眼毬震顫患者分為4組,Ⅰ組:頭位扭轉角＜15°,水平斜視度≤15△,行本體感受器切除術；Ⅱ組:頭位扭轉角＜15°,水平斜視度＞15△,行本體感受器切除術聯閤斜視矯正術；Ⅲ組:頭位扭轉角≥15°,水平斜視度≤15△,行中間帶移位術(部分同時施行本體感受器切除術)；Ⅳ組:患者頭位扭轉角≥15°,水平斜視度＞15△,行中間帶移位聯閤斜視矯正術(部分同時施行本體感受器切除術),採用自身對照法對患者手術前後單眼及雙眼遠近最佳矯正視力、頭位扭轉角、斜視度、眼毬運動及立體視覺的變化進行比較.結果與術前相比,術後各組患者第一眼位單眼及雙眼遠視力均明顯提高,差異均有統計學意義(單眼:t=6.00、8.94、11.76、16.41,P=0.00；雙眼:t=4.81,P=0.01；t=6.27、4.25、4.18,P=0.00).術後Ⅰ組和Ⅱ組患者單眼及雙眼近視力與術前比較差異無統計學意義(單眼:t=1.63,P=0.18；t=1.17,P=0.26;雙眼:t=2.45,P=0.07;t=2.09,P=0.06),而Ⅲ組和Ⅳ組患者術後單眼及雙眼近視力均明顯提高(單眼:t=2.91,P=0.01；t=5.32,P=0.00；雙眼:t=3.36、4.30,P=0.00).Ⅲ組和Ⅳ組中,術前有代償頭位的41例中,術後39例代償頭位消失,2例明顯改善,頭位扭轉角手術前後比較差異有統計學意義(t=29.90、16.91,P=0.00).術前26例閤併斜視的患者中術後24例患者眼位正位,2例患者斜視欠矯,Ⅱ組、Ⅳ組斜視度明顯降低,手術前後比較差異均有統計學意義(t=29.15、36.79,P=0.00).所有患者術後眼毬運動無受限.術前12歲以下的患兒共23例,立體視覺平均為256.52″±66.23″,術後1年其立體視覺平均為120.87″±45.31″,手術前後比較差異有統計學意義(t=12.06,P=0.00).結論 中間帶移位術、本體感受器切除術及斜視矯正術可以改善先天性特髮性眼毬震顫患者的視功能、矯正頭位及斜視.
배경 선천성특발성안구진전적수술방식이일점성숙,단기술후시공능적회복잉연치득관주.목적 탐토선천성특발성안구진전적수술치료방법급기대시공능적영향.방법 안조환자적두위뉴전각대소화사시도수적불동장60례선천성특발성안구진전환자분위4조,Ⅰ조:두위뉴전각＜15°,수평사시도≤15△,행본체감수기절제술；Ⅱ조:두위뉴전각＜15°,수평사시도＞15△,행본체감수기절제술연합사시교정술；Ⅲ조:두위뉴전각≥15°,수평사시도≤15△,행중간대이위술(부분동시시행본체감수기절제술)；Ⅳ조:환자두위뉴전각≥15°,수평사시도＞15△,행중간대이위연합사시교정술(부분동시시행본체감수기절제술),채용자신대조법대환자수술전후단안급쌍안원근최가교정시력、두위뉴전각、사시도、안구운동급입체시각적변화진행비교.결과여술전상비,술후각조환자제일안위단안급쌍안원시력균명현제고,차이균유통계학의의(단안:t=6.00、8.94、11.76、16.41,P=0.00；쌍안:t=4.81,P=0.01；t=6.27、4.25、4.18,P=0.00).술후Ⅰ조화Ⅱ조환자단안급쌍안근시력여술전비교차이무통계학의의(단안:t=1.63,P=0.18；t=1.17,P=0.26;쌍안:t=2.45,P=0.07;t=2.09,P=0.06),이Ⅲ조화Ⅳ조환자술후단안급쌍안근시력균명현제고(단안:t=2.91,P=0.01；t=5.32,P=0.00；쌍안:t=3.36、4.30,P=0.00).Ⅲ조화Ⅳ조중,술전유대상두위적41례중,술후39례대상두위소실,2례명현개선,두위뉴전각수술전후비교차이유통계학의의(t=29.90、16.91,P=0.00).술전26례합병사시적환자중술후24례환자안위정위,2례환자사시흠교,Ⅱ조、Ⅳ조사시도명현강저,수술전후비교차이균유통계학의의(t=29.15、36.79,P=0.00).소유환자술후안구운동무수한.술전12세이하적환인공23례,입체시각평균위256.52″±66.23″,술후1년기입체시각평균위120.87″±45.31″,수술전후비교차이유통계학의의(t=12.06,P=0.00).결론 중간대이위술、본체감수기절제술급사시교정술가이개선선천성특발성안구진전환자적시공능、교정두위급사시.
Background The surgery for congenital idiopathic nystagmus has make great progression recent year,but the influence of surgery on visual function is closely concerned.Objective This work was to study the surgeries for congenital idiopathic nystagmus with or without strabismus and explore the effect of horizontal rectus muscle surgery on the visual function and ocular movement in congenital idiopathic nystagmus.Methods This was a case-observational study.Sixty cases with idiopathic congenital nystagmus were enrolled assigned to four groups as follows:The patients of group Ⅰ appeared the head postures of less than 15 ° and heterotropia less than 15△underwent extraocular proprioceptiou resection,and those of group Ⅱ presented with the head postures of less than 20° and heterotropia more than 15△ underwent extraocular proprioception resection and stabismus surgery.In the group Ⅲ,the patients had the head postures of more than 15° and heterotropia less than 15△ underwent Park's surgery and part of them underwent extraocular proprioception resection) and the cases in group Ⅳ were selected with the head postures of more than15° and heterotropia more than 15△ underwent Park' s surgery and strabismus surgery ( part of them underwent extraocular proprioception resection).Baseline and follow-up evaluations included the best distance and near corrected visual acuity,head posture,ocular movement and Titmus stereotest.The examination results were compared between before and after operation.Results One year after operation,monocular and binocular distance visual acuity improved significantly in all four groups ( monocular:t =6.00,8.94,11.76,16.41,P =0.00 ; binocular:t=4.81,P=0.01 ; t =6.27,4.25,4.18,P =0.00 ),but monocular and binocular near visual acuity improved significantly only in groups Ⅲ and Ⅳ after operation compared with before operation ( monocular:t=2.91,P=0.01 ; t =5.32,P =0.00 ; binocular:t =3.36,t =4.30,P =0.00 ).The compensatory head posture from 39 subjects was disappeared after operation,showing an evident difference between before and after surgery ( group Ⅲ:t =29.90,P=0.00;group Ⅳ:t=16.91,P=0.00).Strabismus were corrected rightly for 24 patients and undercorrection for 2 patients.( group Ⅱ:t =29.15,P =0.00 ; group Ⅳ:t =36.79,P =0.00 ).The binocular visual function of 23 cases with the age below 12 years were improved throughout the follow up duration ( t =12.06,P =0.00).Conclusions Park' s surgery,extraocular proprioception resection and strabismus corrective operation can improve the visual function and head posture in congenital idiopathic nystagmus patients.
