【摘要】：目的：觀察共同性斜視患者手術(shù)前后雙眼視覺的變化，探討不同斜視類型對(duì)術(shù)后雙眼視覺恢復(fù)的影響以及術(shù)后雙眼視覺恢復(fù)的規(guī)律。 方法：選取2010年10月至2011年12月間在我科住院行斜視矯正術(shù)的72例共同性斜視患者，其中男41例，女31例，年齡在3～36歲之間，按斜視類型分為四組：組1，共同性內(nèi)斜視13例；組2，間歇性外斜視27例；組3，恒定性外斜視21例；組4，恒定性外斜視伴下斜肌亢進(jìn)11例。手術(shù)前后分別進(jìn)行眼部常規(guī)檢查，屈光檢查，三棱鏡加交替遮蓋法測(cè)量斜視度，應(yīng)用同視機(jī)檢查雙眼視覺三級(jí)功能，應(yīng)用顏少明編繪的《立體視覺檢查圖》測(cè)定近立體視銳度。記錄術(shù)前、術(shù)后第1天、第7天、1個(gè)月及3個(gè)月的各項(xiàng)檢查數(shù)據(jù)，并對(duì)數(shù)據(jù)資料進(jìn)行統(tǒng)計(jì)學(xué)分析。 結(jié)果： 1.不同斜視類型患者雙眼視覺的比較： ⑴術(shù)前的一般情況：四組間手術(shù)年齡、發(fā)病年齡及術(shù)前斜視度的差異均無統(tǒng)計(jì)學(xué)意義（P0.05）。四組間術(shù)前同時(shí)視、融合功能、遠(yuǎn)立體視及近立體視的差異均無統(tǒng)計(jì)學(xué)意義（P0.05）。 ⑵術(shù)后Ⅰ級(jí)同時(shí)視功能：組2（23例，85.2%）術(shù)后同時(shí)視的恢復(fù)明顯優(yōu)于組1（7例，53.8%）、組3（12例，57.1%）及組4（6例，54.5%），其差異有統(tǒng)計(jì)學(xué)意義（P0.05）。 ⑶術(shù)后II級(jí)融合功能：組2（19例，70.4%，19.3°±3.1°）術(shù)后融合功能及融合范圍的恢復(fù)明顯優(yōu)于組1（5例，38.5%，6.3°±4.8°）、組3（9例，42.9%，14.1°±3.7°）及組4（3例，，27.3%，12.4°±7.5°），其差異有統(tǒng)計(jì)學(xué)意義（P0.05）。 ⑷術(shù)后III級(jí)遠(yuǎn)立體視：組2（8例，29.6%）術(shù)后遠(yuǎn)立體視的恢復(fù)明顯優(yōu)于組1（0例），其差異有統(tǒng)計(jì)學(xué)意義（P0.05）。 ⑸術(shù)后近立體視：組2（24例，88.9%）術(shù)后近立體視的恢復(fù)明顯優(yōu)于組1（5例，38.5%）、組3（11例，52.4%）及組4（8例，72.7%），其差異有統(tǒng)計(jì)學(xué)意義（P0.05）。 2.手術(shù)前后雙眼視覺的比較： 共同性斜視患者術(shù)后雙眼視覺三級(jí)功能及近立體視的恢復(fù)明顯優(yōu)于術(shù)前，其差異有統(tǒng)計(jì)學(xué)意義（P0.05）。術(shù)后第1天與第7天之間比較；術(shù)后1個(gè)月與3個(gè)月之間比較雙眼視覺三級(jí)功能及近立體視恢復(fù)的差異無統(tǒng)計(jì)學(xué)意義（P0.05）。 結(jié)論： 1.共同性斜視患者均有不同程度的雙眼視覺損害。 2.共同性斜視術(shù)后雙眼視覺三級(jí)功能及近立體視較術(shù)前均有明顯改善，手術(shù)是恢復(fù)和重建雙眼視覺的有效方法。 3.間歇性外斜視雙眼視覺的恢復(fù)優(yōu)于非調(diào)節(jié)性內(nèi)斜視、恒定性外斜視以及恒定性外斜視伴下斜肌亢進(jìn)，而非調(diào)節(jié)性內(nèi)斜視、恒定性外斜視以及恒定性外斜視伴下斜肌亢進(jìn)對(duì)雙眼視覺的影響一致。 4.共同性斜視術(shù)后1個(gè)月與3個(gè)月雙眼視覺的恢復(fù)無顯著差異，雙眼視覺的恢復(fù)在術(shù)后1個(gè)月左右基本穩(wěn)定。
[Abstract]:Objective: to observe the changes of binocular vision in concomitant strabismus patients before and after operation, and to explore the effect of different strabismus types on postoperative binocular visual recovery and the regularity of binocular visual recovery. Methods: from October 2010 to December 2011, 72 concomitant strabismus patients were selected, including 41 males and 31 females, aged between 3 and 36 years. According to the type of strabismus, they were divided into four groups: group 1, concomitant esotropia (n = 13), group 2, intermittent exotropia (n = 27), group 3, constant exotropia (n = 21), group 4, constant exotropia (n = 11) with hypertropism. Eye routine examination, refractive examination, prism and alternate shading method were performed before and after operation respectively. The third degree of binocular vision was examined by the same vision machine, and the near stereopsis acuity was measured by the stereopsis chart drawn by Yan Shaoming. The data of pre-operation, 1st day, 7th day, 1st month and 3rd month were recorded, and the data were analyzed statistically. Results: 1. Comparison of binocular vision in patients with different strabismus types: 1General situation before operation: the age of operation, the age of onset and the degree of strabismus were not significantly different among the four groups (P0.05). Preoperative simultaneous vision and fusion function among the four groups, There was no significant difference between distant stereopsis and proximal stereopsis (P0.05). 2 after operation, the recovery of simultaneous vision in group 2 (23 cases, 85.2%) was significantly better than that in group 1 (7 cases, 53.8%), group 3 (12 cases, 57.1%) and group 4 (group 4, 54.5%), the difference was statistically significant. 3 postoperative grade II fusion function in group 2 (19 cases, 19.3 擄鹵3.1 擄) was significantly better than that in group 1 (5 cases, 38.5 擄鹵4.8 擄), group 3 (9 cases, 42.9 擄鹵3.7 擄) and group 4 (3 cases, 27.312.4 擄鹵7.5 擄), the difference was statistically significant (P0.05). The recovery of distant stereopsis in group 2 (8 cases, 29.6%) was significantly better than that in group 1 (0 cases), the difference was statistically significant (P0.05). 5 the recovery of near stereopsis in group 2 (24 cases, 88.9%) was significantly better than that in group 1 (5 cases, P0.05). 38.5%, group 3 (11 cases, 52.4%) and group 4 (8 cases, 72.7%), the difference was statistically significant (P0.05). Comparison of binocular vision before and after operation: postoperative concomitant strabismus patients had significantly better recovery of binocular visual function and near stereopsis than before operation (P0.05). There was no significant difference in visual function and near stereopsis between 1 month and 3 months after operation (P0.05). Conclusion: 1. Concomitant strabismus patients have different degrees of binocular visual impairment. 2. 2. After concomitant strabismus, the third degree function of binocular vision and the near stereopsis were improved obviously. Surgery is an effective method to restore and reconstruct binocular vision. 3. The recovery of binocular vision of intermittent exotropia was superior to that of non-adjustable esotropia, constant exotropia and constant exotropia with hyper inferior oblique muscle, but not accommodative esotropia. The effects of constant exotropia and constant exotropia with inferior oblique hyperactivity on binocular vision were consistent. 4. There was no significant difference in the recovery of binocular vision between 1 month and 3 months after concomitant strabismus. The recovery of binocular vision was basically stable at about 1 month after operation.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R779.6

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