上斜肌麻痹患者斜视矫正术后眼球旋转状态的改变  

Investigations on cyclotorsion changes following strabismus surgery in superior oblique palsy patients

作　　者：韦严[1] 亢晓丽[1] 董凌燕[1] 岑洁[1] 陈奕烨[1] 许宇[1] 

机构地区：[1]上海交通大学医学院附属新华医院眼科,200092

出　　处：《中华眼科杂志》2011年第9期797-800,共4页Chinese Journal of Ophthalmology

基　　金：基金项目：上海市重点学科建设项目（S30205）

摘　　要：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、90d行双眼眼底照相检查，使用绘图软件测量黄斑一视乳头夹角，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一视乳头夹角为右眼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，术前双眼眼底黄斑一视乳头夹角为患眼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Objective To investigate cyclotorsion changes after strabismus surgery in superior oblique palsy patients. Methods Forty patients （50 eyes） underwent myotomy of inferior oblique （15 patients, 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 cyelotorsion 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 wasnot 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° ±d. 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

关 键 词：眼肌麻痹 斜视 眼外科手术 眼球运动 

分 类 号：R779.6[医药卫生—眼科]