OrbitTM1.8生物力学计算机模拟系统在先天性上斜肌不全麻痹诊断和治疗中的初步应用

目的　初步评价OrbitTM1 8生物力学计算机模拟系统在先天性上斜肌不全麻痹诊断和治疗中的应用价值。方法　对 15例先天性上斜肌不全麻痹患者行手术治疗 ,手术前、后分别行Hess屏和其他相关检查。应用OrbitTM1 8生物力学计算机模拟系统模拟改变受累眼外肌的收缩力、弹性、神经支配等参数 ,并根据相关眼外肌的继发改变 ,构建先天性上斜肌不全麻痹模型 ,分析 15例先天性上斜肌不全麻痹患者的病因、制定手术方案、预测手术效果 ,并将模拟效果与手术实际效果进行比较。结果　实际Hess屏检测 2 1个注视方向的眼位结果与OrbitTM 1 8生物力学计算机模拟系统结果的平均差值 ,斜视矫正术前水平方向为 1 6 6°± 0 4 4° ,垂直方向为 1 97°± 0 5 1° ;斜视矫正术后水平方向为 1 2 1°± 0 34° ,垂直方向为 1 5 9°± 0 4 1°。OrbitTM1 8生物力学模型的眼位和眼球运动模拟直观效果与临床体征相符。结论　OrbitTM1 8生物力学计算机模拟系统可较为准确反映正常和异常眼球运动的力学因素及其相互作用关系 ,展示眼球和眼外肌的三维图像和相关数据 ,为设计斜视矫正手术方案和预测手术效果提供直观的临床信息 ,有望成为斜视诊断和治疗的有效辅助方法。

Applications of Orbit 1.8 Computer Biomechanics Simulation for diagnosis and treatment of congenital superior oblique paresis

OBJECTIVE: To evaluate the significance of Orbit 1.8 Computer Biomechanics Simulation in the diagnosis and treatment of congenital superior oblique paresis. METHODS: Fifteen patients with congenital superior oblique paresis were enrolled in the present study. Hess test and other strabismus tests were performed before and after the surgery. Parameters such as contractile force, elasticity, innervation of extraocular muscles and the secondary changes in other muscles were treated by the Orbit 1.8 to simulate the preoperative situation. A biomechanical strabismus model was created. Surgical manipulations were tested on the model to predict postoperative outcomes. After surgery, simulated and actual outcomes were compared. RESULTS: The predicted results matched with the actual results quite well. Before the surgery, the mean difference between these two data was 1.66 degrees +/- 0.44 degrees in horizontal and 1.97 degrees +/- 0.51 degrees in vertical gaze. After surgery, mean difference in horizontal and vertical gaze of these two data was 1.21 degrees +/- 0.34 degrees and 1.59 degrees +/- 0.41 degrees. CONCLUSIONS: Orbit 1.8 Computer Biomechanics Simulation offers a biomechanical approach to understand all of the forces that combine to control eye movement and how these forces interact in normal eyes and in eyes with motility problems. It can be used to reflect the causes of strabismus, to design the surgical procedure, to verify the diagnosis and to predict the outcome of surgery. It is a helpful tool in the diagnosis and treatment of ocular motility disorders.