不同类型婴儿眼球震颤综合征的手术疗效初步观察

发布时间：2018-06-22 12:27

本文选题：眼震 + 先天性　；参考：《山东大学》2012年硕士论文

【摘要】：研究背景和目的：婴儿眼球震颤综合征,既往称谓先天性眼球震颤,是一种在婴儿出生或出生后早期发生的、以双眼非自主性共轭摆动为临床特征的眼球运动疾病,可以引起弱视、侧视、斜视、斜颈等并发症。该病确切病因不明,且无法完全治愈。本病的治疗目的是提高视力、减少眼球震颤的频率和幅度、将中间带移至第一眼位以减轻代偿头位、矫正并存的斜视等。目前治疗方法有视光学、药物、生物反馈以及手术治疗等,以手术治疗为主。根据患者是否存在代偿机制及代偿机制的不同,手术治疗方法也不同。对于存在反转运动代偿机制的患者,主要手术方法是矫正代偿头位的Parks术式和慢相肌后徙手术；对于存在集合阻滞代偿机制的患者,主要手术方法为人工眼位散开术；而对于无代偿机制的患者,主要治疗方法为眼外肌超常量后徙术和四条直肌断腱再缝合术。本文旨在初步探讨不同类型的婴儿眼球震颤综合征手术治疗的疗效。方法：回顾性病例系列研究。对2011年6月到2012年4月期间,于我院行手术治疗的婴儿眼球震颤综合征患者共33例,其中男性23例,女性10例,年龄3～24岁,平均8.28岁。其中水平性眼球震颤30例,垂直性眼球震颤1例,混合性眼球震颤2例。合并代偿头位者20例。其中水平头位19例,头位扭转角在≤30。的13例,30-45。之间的6例；垂直头位1例,头位扭转角在10-15。之间。8例患者存在有明显的集合阻滞,14例合并有斜视,2例合并代偿性摇头。所有患者术前均检查头正位和代偿头位时的单眼及双眼矫正视力、屈光状态、三棱镜加遮盖-去遮盖法测量斜视度、整形量角器(Orthopedic goniometer)或分规测量法测量头位扭转角、直接目测法分析眼球震颤的类型和方向。对存在集合阻滞的患者术前使用Worth四点灯和Titmus立体视图检查患者融合功能和立体视功能。根据患者是否存在代偿机制及代偿机制的不同,采取不同的手术方法治疗。对于存在反转运动代偿机制的患者,主要治疗方法是矫正代偿头位：慢相肌后徙手术及Parks术式；对于存在集合阻滞代偿机制的患者,主要治疗方法为人工眼位散开术,即双内直肌后徙；对于无代偿机制的患者,采用四条直肌断腱再缝合术；合并斜视的患者依照对注视眼手术以矫正头位、对斜视眼手术以矫正眼位的原则制定手术量。术后随访1周～4个月,平均随访时间为3.7周。术后疗效评价标准为：斜视度-8～+8PD为正位；代偿头位-10-+10。为矫正效果满意。结果：(1)头正位时双眼最佳矫正视力：33例中2例因年幼无法配合视力检查。在能够配合视力检查的31例中,术后头正位时双眼视力无变化者7例(21.2%)；提高1行者12例(36.4%)；提高2行者9例(27.3%)；提高≥3行者3例(9.1%)。术前与术后头正位时双眼最佳矫正视力比较,视力提高具有统计学意义(P=0.00)。(2)代偿头位(AHP)：以术后代偿头位在-10-+10。范围以内为AHP矫正效果满意,在23例合并代偿头位的患者中,20例(87.0%)AHP矫正效果满意；3例改善,残留10-15。AHP。4例患者术后面转向对侧,术后2-6周复查其中3例AHP得以矫正,另1例残留15。AHP。(3)眼位：以≤±8PD为眼位正位的标准,在14例合并斜视的患者中,术后眼位正位9例；5例斜视度在15PD以内。(4)对于存在反转代偿机制、不合并斜视的12例患儿,7例低龄患儿采取慢相肌后徙术,术后视力平均提高1.43行,AHP矫正效果满意者5例(71.4%)；另外5例患者行Parks术式,术后视力平均提高0.8行,AHP矫正效果满意者4例(80.0%)。结论：(1)对于不同类型的婴儿眼球震颤综合征,采用不同眼外肌手术方式治疗可以增进视力、改善头位,还可能减轻眼球震颤的幅度和频率。(2)对于合并斜视的婴儿眼球震颤综合症患者,按照对注视眼手术以矫正头位、对斜视眼手术以矫正眼位的原则进行手术治疗,可以获得较为理想的头位和眼位矫正效果。(3)对于存在明显代偿头位的低龄患儿,慢相肌后徙手术可改善头位,增进视力,获得与Parks术式相似的效果,且保留两条水平肌,手术操作简单,为后期治疗提供保障。
[Abstract]:Background and objective: infant nystagmus syndrome (nystagmus), formerly known as congenital nystagmus, is a kind of eye movement disease, which occurs at the birth or early postnatal period of the baby, with the non autonomic conjugated swing of the binocular as clinical features. It can cause amblyopia, lateral vision, strabismus, and torticollis. The exact cause of the disease is unknown and can not be finished. The purpose of the treatment is to improve visual acuity, reduce the frequency and amplitude of nystagmus, move the middle band to the first position to reduce the compensatory head and correct the coexistence of strabismus. At present, the treatment is optic, drug, biofeedback, and surgical treatment. There are different methods of surgical treatment. For patients with reverse motion compensatory mechanisms, the main operative method is to correct the compensatory head Parks and slow phase muscle migration; for the patients with collective block compensatory mechanism, the main surgical method is artificial eye opening; for patients with non compensatory mechanisms, The main treatment method is extraocular muscle supernormal migration and four rectus tendon rupture suture. The aim of this paper is to discuss the curative effect of different types of infants with nystagmus syndrome.
Methods: a retrospective case series study. From June 2011 to April 2012, 33 cases of nystagmus syndrome were performed in our hospital, including 23 males, 10 females, 3~24 years old and 8.28 years old, including 30 cases of horizontal nystagmus, 1 cases of vertical nystagmus and 2 cases of mixed nystagmus. There were 20 cases of head position, of which there were 19 cases of horizontal head position, 13 cases of head twist angle in less than 30., 6 cases between 30-45., 1 cases of vertical head position, and.8 cases with head twist angle between 10-15., there were obvious set block, 14 cases with strabismus, 2 with compensatory head. All patients examined head position and compensatory head monocular and double in all patients before operation. Eye correction visual acuity, refractive state, three prism plus cover method to measure the strabismus degree, Orthopedic goniometer or divider measurement to measure head twist angle, direct visual method to analyze the type and direction of nystagmus. Patients with collective block use Worth four light and Titmus stereoscopic view to check patients' melting before operation. Combined function and stereoscopic function. According to the difference in the compensatory mechanism and the compensatory mechanism of the patient, different surgical methods are taken. For the patients with reverse motion compensation mechanism, the main treatment is to correct the compensatory head: the slow phase muscle migration and the Parks operation; for the patients who have the collective block compensatory mechanism, the main treatment is for the patients who have the collective block compensatory mechanism. The treatment method is artificial eye dissection, that is, double internal rectus muscle migration; for patients without compensatory mechanism, four rectus muscles are used to repair the tendon and then suture. The patients with strabismus combined with eye surgery to correct the head position and the principle of orthodontic surgery to correct the eye position. The follow-up time is 1 weeks to 4 months, and the average follow-up time is followed. For 3.7 weeks, the standard of postoperative curative effect was: the degree of strabismus was -8 to +8PD, and the compensatory head -10-+10. was satisfactory.
Results: (1) the best corrected visual acuity at the head position: of the 33 cases, 2 were unable to cooperate with the vision examination. In 31 cases with visual acuity, 7 cases (21.2%) had no changes in the eyes, 12 cases (36.4%), 2 traveler (27.3%), and 2 travelers, and 2 travelers. Compared with the best corrected visual acuity, the improvement of vision was statistically significant (P=0.00). (2) compensatory head position (AHP): the effect of AHP correction was satisfactory with the postoperative compensatory head within the range of -10-+10.. Among the 23 patients with compensatory head, 20 cases (87%) AHP corrected fruit satisfaction; 3 cases improved, and the residual 10-15.AHP.4 patients turned after the operation. Side, 2-6 weeks after the operation, 3 cases of AHP were corrected, and the other 1 cases with residual 15.AHP. (3) eyes: the standard of eye position with less than + 8PD as eye position, 9 cases of postoperative ocular position in 14 cases with strabismus and 5 cases of strabismus within 15PD. (4) there were 12 cases of reverse compensatory mechanism, 12 patients without strabismus, 7 low age children after slow phase muscle. The average visual acuity increased 1.43 lines after operation, 5 cases (71.4%) were satisfied with the AHP correction, and the other 5 patients were treated with Parks, and the average visual acuity increased 0.8 lines after operation, and 4 cases (80%) were satisfied with the AHP correction effect.
Conclusions: (1) for different types of infant nystagmus syndrome, the use of different extraocular muscles can improve the visual acuity, improve the head position, and may reduce the amplitude and frequency of nystagmus. (2) for the patients with nystagmus syndrome associated with strabismus, the head position and the strabismus operation are corrected according to the eye operation. The principle of correction of eye position for surgical treatment can obtain more ideal head position and eye position correction effect. (3) for children of low age with obvious compensatory head, slow phase muscle migration can improve head position, improve vision, gain similar effect to Parks, and retain two horizontal muscles, operation is simple, provide insurance for later treatment. Barrier.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R779.6

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