合并垂直头位的先天性眼球震颤手术治疗的短期效果  

The short-term effects of surgery for congenital nystagmus with vertical head posture

作　　者：王媛[1] 于刚[1] 曹文红[1] 白大勇[1] 胡守龙[1] 刘雯[1] 樊云葳[1] 吴倩[1] 

机构地区：[1]首都医科大学附属北京儿童医院眼科儿科学国家重点实验室,100045

出　　处：《眼科》2014年第2期115-120,共6页Ophthalmology in China

摘　　要：目的探讨手术治疗合并垂直头位的先天性眼球震颤的效果。设计回顾性病例系列。研究对象2010年7月至2012年3月在北京儿童医院确诊为伴垂直头位的先天性眼球震颤的患儿17例，年龄4～12岁，平均（7．8±2.3）岁。方法以上患者中合并下颌上抬者（7例）采取双眼下直肌减弱＋双眼上斜肌减弱术，合并下颌内收者（10例）采取双眼上直肌减弱＋双眼下斜肌减弱术，合并水平斜视者（4例）同时行水平斜视矫正术，合并集合阻滞现象者（2例）同时行双眼内直肌减弱术。手术量根据患儿具体情况进行设计。术后随访6～23个月，平均（11．2±2．9）个月。观察手术前后代偿头位，双眼中间带最佳矫正视力的变化，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。主要指标代偿头位、双眼中间带最佳矫正视力，眼球震颤频率、振幅及强度的变化。结果术前垂直头位〈15。者4例，15°～30°者7例，〉30。者6例；随访终末垂直头位〈15。者13例，15°-30°者3例，〉30。者1例，与术前相比，差异有统计学意义（x2=9．936，P=0．007）。术后最佳矫正双眼视力（O．26±0．13）比术前（0．22±0．12）有所提高（t=2．66，P=0．017）。术后随访终末眼震频率（2．27Hz）较术前（3．19Hz）明显下降（t=6．77，P=0．000）。术后随访终末眼震振幅（16．6度）较术前（22．9度）明显下降（t=4．132P=0．001）。术后随访终末眼震强度（37．1Hz＊度）较术前（75．1Hz＊度）明显下降（t=6．275，P=0．000）。结论对合并垂直头位的先天性眼球震颤进行手术治疗可有效改善代偿头位，提高视力，减轻眼球震颤的强度。Objective To evaluate the surgery efficacy for congenital nystagmus with vertical head posture. Design Retrospective case series. Participants Seventeen congenital nystagmus patients with vertical head posture, who were diagnosed between July. 2010 and Mar. 2012 in Beijing Children＇s Hospital were enrolled. The ages ranged from 4 to 12 years, average 7.8＋2.3 years. Methods Seven eases with a chin-up posture were accepted the operation of bilateral superior oblique tenectomy ＋ bilateral inferior rectus recession. Ten patients with a chin-clown posture were accepted the operation of bilateral superior rectus recession ＋ inferior oblique tenectomy or myectomy. In which, four cases with horizontal strabismus were accepted bilateral lateral rectus, and two cases with convergence damp- ing were accepted medial rectus recession as well. Degrees of head posture, null zone best corrected visual acuity （BCVA）, the frequen- cy, amplitude and intensity of nystagmus waveform were observed and recorded before and after the surgery. All the participants were followed up 6 to 23 months, averaged 11.2±2.9 months. Main Outcome Measures Degrees of head posture, null zone BCVA, and the frequency, amplitude and intensity of nystagmus waveform before and after the surgery. Results The degree of head posture was less than 15°in 4 cases, between 15°and 30°in 7 cases, and more than 30 ~in 6 cases preoperatively; and less than 15°in 13 cases, between 15°and 30°in 3 cases, more than 30 °1 cases at the end of follow up （X2=9.936, P=0.007）. Null zone BCVA increased from 0.22＋0.12 preoperatively to 0.26＋0.13 postoperatively （t=-2.66, P=0.017） , and the frequency （3.19 Hz preoperatively to 2.27 Hz postoperatively, t=6.77, P=O.O00）, amplitude （22.9 degrees preoperatively to 16.6 degrees postoperatively, t=4.132, P=0.001 ）and intensity（75.1 Hz＊de- gree preoperatively to 37.1 Hz＊degree postoperatively, t=6.275, P=0.000）of nystagmus waveforms were significantly improved. Conclu- sion Surgery treatmen

关 键 词：先天性眼球震颤 外科学 异常头位 眼肌手术 

分 类 号：R779.6[医药卫生—眼科]