CAJ | 학술논문

目的探讨手术治疗伴有集合抑制的先天性眼球震颤的效果.方法回顾性系列病例研究.收集自2010年9月至2012年9月在首都医科大学附属北京儿童医院确诊为伴有集合抑制的先天性眼球震颤患儿的临床资料8例,年龄中位数为9.5(12,6)岁,随访时间中位数为9(24,6)个月,对所有患儿均进行光学诱导集合并采取双眼内直肌后徙加双眼外直肌断腱后原位缝合的手术方法,分析诱导集合前后及手术前后双眼最佳矫正视力,融合范围的变化,使用眼震仪测量手术前后眼球震颤的频率、振幅及强度的变化.使用SPSS13.0统计学软件对诱导集合前后及手术前后视力、眼震频率、振幅及强度进行配对t检验.结果使用同视机测定手术前后融合范围,术前平均融合范围为-3.75°±1.83°～+19.38°±3.16°,术后平均融合范围为-3.88°±1.55°～+19.00°±3.02°,差异无统计学意义(t=0.24,P=0.82),对使用集合前后及手术前后最佳矫正双眼视力进行配对比较,使用集合前平均视力为0.21±0.15,使用集合后平均视力为0.28±0.18,使用集合后视力较术前有所提高,差异有统计学意义(t=-4.43,P=0.00).术后平均视力为0.32±0.20,术后视力较术前使用集合前的视力有所提高,差异有统计学意义(t=-5.29,P=0.00),与术前使用集合后的视力相比,差异无统计学意义(t=-2.12,P=0.07),术前使用集合功能后及术后眼震频率(t=3.28,3.02,P＜0.05)及眼震强度较(t=3.27,3.48,P＜0.05)术前使用集合前下降,差异有统计学意义.眼震振幅的变化无统计学意义(t=1.31,1.57,0.31,P＞0.05).结论双眼内直肌后徙加双眼外直肌断腱再缝合手术可以有效改善伴有集合抑制的先天性眼球震颤患儿的眼震强度及视力,手术对融合范围没有明显影响.集合抑制现象对于眼球震颤频率的影响要大于对其振幅的影响.
목적 탐토수술치료반유집합억제적선천성안구진전적효과.방법 회고성계렬병례연구.수집자2010년9월지2012년9월재수도의과대학부속북경인동의원학진위반유집합억제적선천성안구진전환인적림상자료8례,년령중위수위9.5(12,6)세,수방시간중위수위9(24,6)개월,대소유환인균진행광학유도집합병채취쌍안내직기후사가쌍안외직기단건후원위봉합적수술방법,분석유도집합전후급수술전후쌍안최가교정시력,융합범위적변화,사용안진의측량수술전후안구진전적빈솔、진폭급강도적변화.사용SPSS13.0통계학연건대유도집합전후급수술전후시력、안진빈솔、진폭급강도진행배대t검험.결과 사용동시궤측정수술전후융합범위,술전평균융합범위위-3.75°±1.83°～+19.38°±3.16°,술후평균융합범위위-3.88°±1.55°～+19.00°±3.02°,차이무통계학의의(t=0.24,P=0.82),대사용집합전후급수술전후최가교정쌍안시력진행배대비교,사용집합전평균시력위0.21±0.15,사용집합후평균시력위0.28±0.18,사용집합후시력교술전유소제고,차이유통계학의의(t=-4.43,P=0.00).술후평균시력위0.32±0.20,술후시력교술전사용집합전적시력유소제고,차이유통계학의의(t=-5.29,P=0.00),여술전사용집합후적시력상비,차이무통계학의의(t=-2.12,P=0.07),술전사용집합공능후급술후안진빈솔(t=3.28,3.02,P＜0.05)급안진강도교(t=3.27,3.48,P＜0.05)술전사용집합전하강,차이유통계학의의.안진진폭적변화무통계학의의(t=1.31,1.57,0.31,P＞0.05).결론 쌍안내직기후사가쌍안외직기단건재봉합수술가이유효개선반유집합억제적선천성안구진전환인적안진강도급시력,수술대융합범위몰유명현영향.집합억제현상대우안구진전빈솔적영향요대우대기진폭적영향.
Objective To evaluate the efficacy of surgery in the treatment of congenital nystagmus with convergence damping.Methods Retrospective and comparative case series.Eight patients diagnosed as congenital nystagmus with convergence damping at Beijing Children's Hospital between September 2010 and September 2012 were enrolled in this study.The ages were 9.5 (12,6)years old, and follow-up was 9 (24, 6) months.All patients received prism induced convergence and the same surgery of bimedial rectus recession and bilateral rectus tenotomy.The best corrected visual acuity, the range of fusion and the nystagmus waveforms were analyzed before and after surgery.Results The range of fusion was-3.75±1.83° to + 19.38±3.16°before surgery and-3.88± 1.55°to + 19.00±3.02° after surgery;there was no significant difference (t=0.24, P=0.82).The binocular visual acuity increased from 0.21±0.15 without convergence to 0.28 ± 0.18 using convergence;there was significant difference (t=-4.43, P=0.00).The visual acuity was 0.32±0.20 after surgery, significantly different from that before surgery without convergence (t=-5.29, P=0.00), but not significantly different from that before surgery using convergence (t=-2.12, P=0.07).Patients had significant improvements in the frequency (t=3.28, 3.02, P＜0.05)and intensity of the nystagmus waveforms when using convergence and postoperatively (t=3.27,3.48;P＜0.05), but there was no significant improvement in the amplitude of the waveforms (t=1.31,1.57,0.31, P＞0.05).Conclusions Surgery for congenital nystagmus with convergence damping can provide expectations for ocular motor and visual results.The range of fusion should be wide enough, and the effect of convergence on the frequency is greater than that on the amplitude.