本文選題：眼震 + 先天性��； 參考：《山東大學》2012年碩士論文

【摘要】：研究背景和目的：嬰兒眼球震顫綜合征,既往稱謂先天性眼球震顫,是一種在嬰兒出生或出生后早期發(fā)生的、以雙眼非自主性共軛擺動為臨床特征的眼球運動疾病,可以引起弱視、側視、斜視、斜頸等并發(fā)癥。該病確切病因不明,且無法完全治愈。本病的治療目的是提高視力、減少眼球震顫的頻率和幅度、將中間帶移至第一眼位以減輕代償頭位、矯正并存的斜視等。目前治療方法有視光學、藥物、生物反饋以及手術治療等,以手術治療為主。根據患者是否存在代償機制及代償機制的不同,手術治療方法也不同。對于存在反轉運動代償機制的患者,主要手術方法是矯正代償頭位的Parks術式和慢相肌后徙手術；對于存在集合阻滯代償機制的患者,主要手術方法為人工眼位散開術；而對于無代償機制的患者,主要治療方法為眼外肌超常量后徙術和四條直肌斷腱再縫合術。本文旨在初步探討不同類型的嬰兒眼球震顫綜合征手術治療的療效。 方法：回顧性病例系列研究。對2011年6月到2012年4月期間,于我院行手術治療的嬰兒眼球震顫綜合征患者共33例,其中男性23例,女性10例,年齡3～24歲,平均8.28歲。其中水平性眼球震顫30例,垂直性眼球震顫1例,混合性眼球震顫2例。合并代償頭位者20例。其中水平頭位19例,頭位扭轉角在≤30。的13例,30-45。之間的6例；垂直頭位1例,頭位扭轉角在10-15。之間。8例患者存在有明顯的集合阻滯,14例合并有斜視,2例合并代償性搖頭。所有患者術前均檢查頭正位和代償頭位時的單眼及雙眼矯正視力、屈光狀態(tài)、三棱鏡加遮蓋-去遮蓋法測量斜視度、整形量角器(Orthopedic goniometer)或分規(guī)測量法測量頭位扭轉角、直接目測法分析眼球震顫的類型和方向。對存在集合阻滯的患者術前使用Worth四點燈和Titmus立體視圖檢查患者融合功能和立體視功能。根據患者是否存在代償機制及代償機制的不同,采取不同的手術方法治療。對于存在反轉運動代償機制的患者,主要治療方法是矯正代償頭位：慢相肌后徙手術及Parks術式；對于存在集合阻滯代償機制的患者,主要治療方法為人工眼位散開術,即雙內直肌后徙；對于無代償機制的患者,采用四條直肌斷腱再縫合術；合并斜視的患者依照對注視眼手術以矯正頭位、對斜視眼手術以矯正眼位的原則制定手術量。術后隨訪1周～4個月,平均隨訪時間為3.7周。術后療效評價標準為：斜視度-8～+8PD為正位；代償頭位-10-+10。為矯正效果滿意。 結果：(1)頭正位時雙眼最佳矯正視力：33例中2例因年幼無法配合視力檢查。在能夠配合視力檢查的31例中,術后頭正位時雙眼視力無變化者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%)。術前與術后頭正位時雙眼最佳矯正視力比較,視力提高具有統(tǒng)計學意義(P=0.00)。(2)代償頭位(AHP)：以術后代償頭位在-10-+10。范圍以內為AHP矯正效果滿意,在23例合并代償頭位的患者中,20例(87.0%)AHP矯正效果滿意；3例改善,殘留10-15。AHP。4例患者術后面轉向對側,術后2-6周復查其中3例AHP得以矯正,另1例殘留15。AHP。(3)眼位：以≤±8PD為眼位正位的標準,在14例合并斜視的患者中,術后眼位正位9例；5例斜視度在15PD以內。(4)對于存在反轉代償機制、不合并斜視的12例患兒,7例低齡患兒采取慢相肌后徙術,術后視力平均提高1.43行,AHP矯正效果滿意者5例(71.4%)；另外5例患者行Parks術式,術后視力平均提高0.8行,AHP矯正效果滿意者4例(80.0%)。 結論：(1)對于不同類型的嬰兒眼球震顫綜合征,采用不同眼外肌手術方式治療可以增進視力、改善頭位,還可能減輕眼球震顫的幅度和頻率。(2)對于合并斜視的嬰兒眼球震顫綜合癥患者,按照對注視眼手術以矯正頭位、對斜視眼手術以矯正眼位的原則進行手術治療,可以獲得較為理想的頭位和眼位矯正效果。(3)對于存在明顯代償頭位的低齡患兒,慢相肌后徙手術可改善頭位,增進視力,獲得與Parks術式相似的效果,且保留兩條水平肌,手術操作簡單,為后期治療提供保障。
[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.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R779.6

【參考文獻】

相關期刊論文 前1條

1 胡俊喜;先天性眼球震顫的研究進展[J];國外醫(yī)學.眼科學分冊;1995年02期

，

本文編號：2052832