目的探讨单纯Knapp手术在双上转肌麻痹（double elevator palsy，DEP）治疗中的手术效果。方法对2007年1月至2015年6月，回顾性分析在天津市眼科医院应用Knapp斜视矫正手术治疗的15例DEP患者，观察术前与术后眼位、斜视度数、患眼上转...目的探讨单纯Knapp手术在双上转肌麻痹（double elevator palsy，DEP）治疗中的手术效果。方法对2007年1月至2015年6月，回顾性分析在天津市眼科医院应用Knapp斜视矫正手术治疗的15例DEP患者，观察术前与术后眼位、斜视度数、患眼上转和下转功能及双眼视功能的变化。结果Knapp手术治疗前、治疗后原在位平均垂直斜视度分别为（34.67±8.55）PD、（6.53±6.50）PD，差异有统计学意义（P 〈0.05），平均垂直斜视矫正量（28.13±3.58）PD。术前、术后眼球上转运动分级分别为（-3.73±0.70）和（-1.8±0.77）差异有统计学意义（P 〈0.05），上转运动改善（1.93±0.59）。术后眼球下转运动轻度受限（-0.80±0.41）。术前5例代偿头位下有双眼视功能患者，术后代偿头位消失或〈5°，于功能眼位（原在位和阅读视野）获得双眼视觉。单纯Knapp手术对DEP一次手术治愈率73.3%，术前原在位垂直斜视度≥40 PD患者欠矫明显，需要二次手术。结论单纯Knapp手术适用于下无下直肌限制因素的DEP，显著改善麻痹眼上转运动和矫正原在位垂直斜视，有助于双眼视功能的恢复。展开更多
AIM： To describe the clinical features of congenital double elevator palsy（CDEP） and to evaluate various surgical outcomes between the standard Knapp and augmented Knapp procedures, based on improvements in primary...AIM： To describe the clinical features of congenital double elevator palsy（CDEP） and to evaluate various surgical outcomes between the standard Knapp and augmented Knapp procedures, based on improvements in primary eye position and ocular motility.METHODS： Twenty-two patients with CDEP at Shanghai Children＇s Hospital were enrolled from July 2014 to January 2018. The forced duction test（FDT） was negative in 21 patients, aged 8 mo to 12 y（mean 5.4 y）. Patients were divided into two treatment groups： 16 patients underwent the standard Knapp procedure（group A）, with or without horizontal squint procedure; and 5 patients underwent the augmented Knapp procedure（Foster procedure; group B）. One patient underwent inferior rectus recession in the affected eye and superior rectus recession in the sound eye because of a positive FDT. The pre-and postoperative vertical deviations in the primary position and ocular motility were compared in the two groups.RESULTS： Twenty-one eyes of the 22 patients（95%） were aligned within 10 prism diopters（PD）, and all patients（100%） reached ≥25% elevation improvement after surgery. The average corrected vertical deviation in group B was statistically better than that of group A. For group A, the vertical deviation in the primary position decreased from 24.75Δ±8.35Δ to 4.56Δ±8.07Δ after surgery, for an improvement of 23.06Δ±6.51Δ（P〈0.05）. In group B, the decrease was from 35.00Δ±5.00Δ（range 30Δ-40Δ） to 1.00Δ±2.24Δ, for an improvement of 34.00Δ±4.18Δ（P〈0.05）. There were significant differences between the pre-and postoperative elevation in each group（group A, P〈0.05; group B, P〈0.05）. The average scale of improved elevation in group B（1.80±0.45） was not significantly better than that of group A（1.69±0.87; Z=-0.732, P=0.548）. The average follow-up periods lasted 21 mo in group A and 18 mo in group B.CONCLUSION： For vertical deviations 〈30Δ, the standard Knapp procedure can be chosen. For deviations greater than 30Δ-40Δ, the Foster procedure should be chosen. Because of our early interference, the inferior rectus（IR） muscle did not show mechanical restriction. Monocular elevation deficiency（MED） should be diagnosed early so that complications will be reduced and the procedure will be easier for the surgeon.展开更多
《Sprint：How to Solve Big Problems and Test New Ideas in Just Five Days》作者：杰克·纳普（Jake Knapp）约翰·泽拉茨基（John Zeratsky）布兰登·科威茨（Braden Kowitz）出版社：西蒙与舒斯特出版公司（Simon＆Sc...《Sprint：How to Solve Big Problems and Test New Ideas in Just Five Days》作者：杰克·纳普（Jake Knapp）约翰·泽拉茨基（John Zeratsky）布兰登·科威茨（Braden Kowitz）出版社：西蒙与舒斯特出版公司（Simon＆Schuster）出版时间：2016年3月谷歌风投（Google Ventures）的三位设计合伙人杰克·纳普、约翰·泽拉茨基、布兰登·科威茨,一套解决重大难题的独一无二的＂五天冲刺法＂——历经超过100家公司的实战洗礼,现在让《谷歌思维法（Sprint）：如何只用5N搞定大问题、测试新想法》告诉你它究竟为何物。展开更多
文摘AIM： To describe the clinical features of congenital double elevator palsy（CDEP） and to evaluate various surgical outcomes between the standard Knapp and augmented Knapp procedures, based on improvements in primary eye position and ocular motility.METHODS： Twenty-two patients with CDEP at Shanghai Children＇s Hospital were enrolled from July 2014 to January 2018. The forced duction test（FDT） was negative in 21 patients, aged 8 mo to 12 y（mean 5.4 y）. Patients were divided into two treatment groups： 16 patients underwent the standard Knapp procedure（group A）, with or without horizontal squint procedure; and 5 patients underwent the augmented Knapp procedure（Foster procedure; group B）. One patient underwent inferior rectus recession in the affected eye and superior rectus recession in the sound eye because of a positive FDT. The pre-and postoperative vertical deviations in the primary position and ocular motility were compared in the two groups.RESULTS： Twenty-one eyes of the 22 patients（95%） were aligned within 10 prism diopters（PD）, and all patients（100%） reached ≥25% elevation improvement after surgery. The average corrected vertical deviation in group B was statistically better than that of group A. For group A, the vertical deviation in the primary position decreased from 24.75Δ±8.35Δ to 4.56Δ±8.07Δ after surgery, for an improvement of 23.06Δ±6.51Δ（P〈0.05）. In group B, the decrease was from 35.00Δ±5.00Δ（range 30Δ-40Δ） to 1.00Δ±2.24Δ, for an improvement of 34.00Δ±4.18Δ（P〈0.05）. There were significant differences between the pre-and postoperative elevation in each group（group A, P〈0.05; group B, P〈0.05）. The average scale of improved elevation in group B（1.80±0.45） was not significantly better than that of group A（1.69±0.87; Z=-0.732, P=0.548）. The average follow-up periods lasted 21 mo in group A and 18 mo in group B.CONCLUSION： For vertical deviations 〈30Δ, the standard Knapp procedure can be chosen. For deviations greater than 30Δ-40Δ, the Foster procedure should be chosen. Because of our early interference, the inferior rectus（IR） muscle did not show mechanical restriction. Monocular elevation deficiency（MED） should be diagnosed early so that complications will be reduced and the procedure will be easier for the surgeon.
文摘《Sprint：How to Solve Big Problems and Test New Ideas in Just Five Days》作者：杰克·纳普（Jake Knapp）约翰·泽拉茨基（John Zeratsky）布兰登·科威茨（Braden Kowitz）出版社：西蒙与舒斯特出版公司（Simon＆Schuster）出版时间：2016年3月谷歌风投（Google Ventures）的三位设计合伙人杰克·纳普、约翰·泽拉茨基、布兰登·科威茨,一套解决重大难题的独一无二的＂五天冲刺法＂——历经超过100家公司的实战洗礼,现在让《谷歌思维法（Sprint）：如何只用5N搞定大问题、测试新想法》告诉你它究竟为何物。
