共同性斜视眼外肌超微结构与手术时机选择的相关性研究

The Study of Ultrastructure and Operation Opportunity on Extraocular Muscles in Comitant Strabismus

目的:通过对共同性斜视患者水平直肌超微结构的观察,探讨共同性斜视的发病机制,为共同性斜视手术时的选择提供理论依据。方法:利用光学显微镜和电子显微镜观察69例共同性斜视患者水平直肌的超微结构,并与30例正常人水平直肌的组织标本进行对比分析。结果:正常人眼水平直肌在光镜下显示肌纤维排列紧密、整齐,方向一致,肌纤维间间质较少;电镜下观察肌细胞膜完整,组织结构清晰,肌原纤维排列整齐、紧密。细胞核呈圆形,电子密度低,线粒体分布均匀,含少量糖元。共同性斜视患者在光镜下可见肌纤维排列疏松,肌纤维数量较少,间质成分多。小年龄组中可见萎缩变性的横纹肌细胞和排列混乱的肌纤维。而大年龄组则只有少量萎缩变性的肌细胞排列在大量胶原纤维结缔组织中。电镜下整个眼肌组织结构模糊,肌膜不完整,细胞内结构紊乱,细胞核固缩。且在大龄组中肌丝紊乱,肌纤维弯曲排列、间隙变宽以及空泡样改变更明显。结论:共同性斜视患者病程越长,肌纤维的损害程度越重,应尽早进行手术治疗,以免发生眼肌组织学上的损害,恢复双眼视功能。

Objective：To study the organize-pathology and micro-stracture of the structure of extraocular muscle about concoinitant strabismus with light and electron microscopy,and to probe the basis of the mechanism about concoinitant strabismus,This study tried to provide on the basis of theory with operation opportunity with concomitant strabismus.Methods：To observe and photograph by light and electron-microscopy the structure of extraocular muscle of 69cases with concomitant strabismus and the architecture of the normal person＇s horizontal extraocular muscle of 30 cases of enucleation of eye.Result：To study observed the architecture of the normal person＇s horizontal extraoular muscle with light and electron microsocopy firstly.Under light microscopy,it was manifested that architecture of the normal person＇s horizontal extraoular muscle fiber was in close order,in same direction and has fewer matrix among muscle fiber.Under electron microscopy,the extraocular muscle cell membrane was complete,histological structure clear and myofibril in close order,cell nucleus round,electron density thin,the mitochondria well scattered and has a few glaucogen.The study also probed the structure of extraocular muscle fiber with concomitant strabismus under light and electron microscopy.There was less muscle fiber in loose order and more matrix in extraoclular muscles in strabismus.In younger group,there were atrophic and degenerated striated muscular cells and mixed fiber.In older group, there were few those muscular cells within much collagen connective tissue.Observed by microscopy,histological structure of extraocular muscles was clounded, with imcomplete cell membrance,disordered cell organs and pyknotic nucleus.It was obvious in older group that extraocular muscle fiber was disordered and curved,interval widened and cells vacuolated.Conclusion：Our study suggests that the longer the concomitant strabismus suffered,the more damage the extraocular muscle.concomitant strabismus should be treated as early as possible by operation,lest the extraocular muscle developed histological changes and made the recovering of the ability of binocular visual reflection.