高度近视性斜视的临床与CT研究

发布时间：2018-11-28 08:42

【摘要】：目的：通过CT扫描技术，从新的角度分析高度近视性内下斜视患者眼直肌的最大横截面积、位移、形态以及外直肌与眼轴长度之间的关系，以对高度近视性斜视有更进一步了解，，并对临床诊断、鉴别诊断及手术方式的选择提供影像学支持。方法：选取2011年1月——2012年12月在山西省眼科医院行眼眶CT检查（机型: NeuViz Dual）并住院手术治疗的高度近视性患者7例（12只眼）作为实验组，8例（16只眼）正常眼眶作对照组。A超测量眼轴长度。冠状位CT图像选视神经与眼球连接处层面，建立以眼眶中心为原点的坐标系，测量各直肌切面中心和坐标原点连线与相邻坐标轴的夹角（以下简称夹角）；另外选视神经与眼球连接层面后6-8mm测量各直肌最大横截面积及其长径与宽径，并计算长径与宽径的比值（RLW）。使用SPSS13.0统计软件进行数据处理。结果：实验组眼轴长度明显增长；两组四条直肌切面中心的夹角t检验：外直肌（P0.05）、上直肌（P0.05）,下直肌(P0.05)，均有统计学意义，内直肌（P=0.7750.05），无统计学意义，说明实验组的外直肌、上直肌及下直肌产生移位，内直肌无明显移位；两组四条直肌最大横截面积t检验，P值均大于0.05，无统计学意义，即两组所有直肌最大横截面积无明显差别；两组各直肌RLW的t检验，内直肌（P=0.03）外直肌（P0.05），上直肌（P=0.02），下直肌（P=0.02）, P值均小于0.05，有统计学意义，可以认为实验组直肌的形态发生了改变；外直肌RLW与眼轴的长度有一定的相关性。结论： 1.高度近视性斜视组眼轴长度与正常组比较明显增长，眼轴过度增长，眼球重量增加形成重眼现象，可能是高度近视眼发生内下斜视的主要原因； 2.高度近视性斜视组的眼直肌中，外直肌、上直肌、下直肌的位置较正常组有明显移位，外直肌移位最明显，内直肌无移位；四条眼直肌的形态均发生了明显改变，也以外直肌改变最明显。眼直肌的改变是由于重眼现象及斜视所导致；眼直肌尤其是外直肌的移位及变形可能是高度近视性内下斜视发生眼球运动障碍的主要原因之一。 3.本研究高度近视性内下斜视组眼轴长度和外直肌移位的角度、外直肌的长径与宽径比值有一定的相关性，但不再是单纯的直线正相关的关系。 4.眼轴明显增长、眼直肌移位、变形、眼球向内下方斜视是高度近视性斜视在CT影像上的特征性表现，根据此征象可提出本病的诊断。
[Abstract]:Objective: to analyze the relationship between the maximal cross sectional area, displacement, shape of rectus muscle and axial length in patients with high myopic endotropia from a new angle by CT scanning. To have a better understanding of high myopic strabismus, and to provide imaging support for clinical diagnosis, differential diagnosis and choice of surgical methods. Methods: from January 2011 to December 2012, 7 patients (12 eyes) with high myopia who underwent orbital CT examination (model: NeuViz Dual) and surgical treatment) were selected as experimental group. 8 cases (16 eyes) of normal orbit were used as control group. In coronal CT images, the optic nerve and eyeball junction were selected and the coordinate system was established with the orbital center as the origin, and the angle between the center of rectus and the origin of the coordinate line and the adjacent coordinate axis was measured (hereinafter referred to as the angle of the coordinate axis). In addition, the maximum cross sectional area, length and width of rectus muscle were measured by 6-8mm after optic nerve and eyeball junction, and the ratio of length to width was calculated by (RLW). Use SPSS13.0 statistical software for data processing. Results: the axial length of the eyes in the experimental group increased obviously. T test of the center of four rectus muscles in the two groups: external rectus (P0.05), superior rectus (P0.05), inferior rectus (P0.05), and medial rectus (P0. 7750.05). The results showed that the external rectus muscle, superior rectus muscle and inferior rectus muscle of the experimental group were translocated, but the inner rectus muscle had no obvious displacement. The maximum cross sectional area of rectus muscle in the two groups was no significant difference (P > 0.05), that is, there was no significant difference in the maximum cross sectional area of all rectus muscles between the two groups. T test of RLW of each rectus muscle in the two groups showed that the values of the medial rectus muscle (P0. 03), the superior rectus muscle (P0. 02) and the inferior rectus muscle (P0. 02), P) were all less than 0. 05, which had statistical significance. It can be considered that the morphology of the rectus muscle in the experimental group has changed. The RLW of the external rectus muscle was correlated with the length of the eye axis. Conclusion: 1. The length of eye axis in high myopic strabismus group was significantly longer than that in normal group. The overgrowth of eye axis and the increase of eyeball weight might be the main reasons for the occurrence of hypotropia in high myopia group. 2. In the high myopic strabismus group, the position of the rectus muscle, the superior rectus muscle, the inferior rectus muscle was more obvious than that of the normal group, the displacement of the external rectus muscle was the most obvious, and there was no displacement of the inner rectus muscle in the high myopia strabismus group. The morphology of the rectus oculis muscle was obviously changed, and the most obvious change was also seen in the external rectus muscle. The change of rectus muscle is caused by the phenomenon of heavy eye and strabismus, and the displacement and deformation of rectus muscle, especially the external rectus muscle, may be one of the main causes of ocular movement disorder in high myopic endotropia. 3. In this study, the axial length and the angle of transposition of the external rectus muscle, the ratio of length to width of the external rectus muscle in the group of high myopic endotropia were related to each other, but were no longer the only linear positive correlation. 4. The obvious increase of eye axis, the displacement and deformation of rectus oculi, and the inward and inferior strabismus of the eyeball are the characteristic manifestations of high myopic strabismus on CT images. The diagnosis of this disease can be made on the basis of this sign.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R816.97;R777.41

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