Orbit^(TM)1.8生物力学模型在非共同性斜视诊断和治疗中的初步应用

Applications of Orbit^(TM)1.8 gaze mechanics simulation for incomitant strabismus diagnosis and treatment

目的 :应用OrbitTM1 8计算机模拟系统构建非共同性斜视的生物力学模型并预测手术矫正效果 ,探讨不同类型斜视的模拟方法以及OrbitTM1 8在斜视诊断和治疗中的应用价值。方法 :收集 15例先天性上斜肌不全麻痹、 1例外伤性内直肌断裂、 1例外展神经不全麻痹、 1例Brown综合征 ,手术前后均进行Hess屏及其它斜视相关检查 ,应用美国MillerJM等开发的OrbitTM1 8眼外肌生物力学模拟系统 ,分析眼外肌的原发和继发改变 ,通过调整相应的生物力学参数 ,建立与临床特征相符的斜视模型 ,据此验证病因推断和假设 ,并对手术方案进行模拟 ,预测术后矫正效果。结果 :构建了全部 18例非共同性斜视的术前生物力学模型 ;17例手术患者的预测矫正效果与手术后检查结果基本吻合。结论 :OrbitTM1 8生物力学模型可以对斜视的病因推断和假设进行测试 ,并预测手术矫正的效果 ,具有辅助诊断和指导手术设计的应用价值。

Objective:To simulate incomitant strabismus with Orbit TM1.8 Gaze Mechanics Simulation,thereby clarify diagnostic and treatment possibilities.We want to discuss the methods of different simulations and evaluate the clinical value of Orbit TM1.8. Methods:Fifteen patients with congenital superior oblique paresis,one with traumatic medial rectus disinsertion,one with six nerve paresis and one with Brown′s syndrome were enrolled.Hess Test and other strabismus tests were performed before and after surgery.In Orbit TM1.8,which was designed by Miller JM from the United States,parameters such as contractile force,elasticity,innervation of extraocular muscles were modified to simulate the preoperative disorder.In experimenting with diagnosis we incorporated whatever we know or suspect:not only changes of the paresis muscle,but also secondary changes in other muscles should be considered.As Orbit TM′s simulated alignment matched clinical data well,preoperative biomechanical strabismus models were created.Surgical manipulations were then applied to the models,so postoperative outcomes could be predicted.After surgery,simulated and actual outcomes were compared. Results:In all the 18 patients,preoperative simulations clarified the diagnosis or hypotheses.As for the 17 patients who had strabismus surgery,their simulated and actual postoperative alignments matched well. Conclusions:Orbit TM1.8 Gaze Mechanics Simulation can be used to reflect supposed causes of strabismus and proposed treatments,thus test the diagnosis and predict the outcome of surgery.It is valuable for diagnosis and treatment of incomitant strabismus.