【摘要】 目的 觀察在表面麻醉下不作結膜瓣和傳統的以穹窿為基底結膜切開的小切口白內障摘除聯合5.5 mm直徑人工晶狀體植入術的臨床效果。 方法 收集2007年1月－2010年12月資料較完整的老年性白內障160例，將160例320只眼隨機分成兩組，每組各80例160只眼。在表面麻醉下行小切口白內障手術。A組不做結膜瓣，行長5.5 mm角鞏膜緣的平行切口； B組行以穹窿為基底的傳統的結膜瓣，做長5.5 mm角鞏膜平行切口；兩組均行手法小切口白內障劈核摘除聯合5.5 mm直徑硬質人工晶狀體植入。觀察術后效果及術后并發癥。 結果 術后1個月，患者眼部舒適者:A組154只眼（96.25%），B組141只眼（88.13%），兩組差異有統計學意義（χ2=7.332，Plt;0.05）。術后結膜退縮、下垂、巨大瘢痕：A組7只眼（4.38%），B組29只眼（18.13%），兩組差異有統計學意義（χ2=15.149，Plt;0.01），兩組患者術后1 d、1周及1個月視力比較：1 d，A組120只眼（75.00%），B組128只眼（80.00%）（χ2=1.467，Pgt;0.05）；1周，A組130只眼（81.25%），B組132只眼（82.25%）（χ2=0.084，Pgt;0.05）；1個月，A組138只眼（86.25%），B組139只眼（86.86%）（χ2=0.027，Pgt;0.05）；角膜水腫于術后2周后均消退。 結論 在表面麻醉下不做結膜瓣較做結膜瓣小切口白內障劈核摘除術聯合人工晶狀體植入術省時、對眼表面破壞小，角鞏膜切口較小且較為隱閉，術后恢復快。在基層醫院是一種較好的白內障手術方法。【Abstract】 Objective To observe the clinical effect of non-conjunctival flaps and traditional conjunctival flaps choper extracapsular cataract extraction (ECCE) on patients with senile cataracts. Methods The clinical data of 160 patients with cataracts between January 2007 and December 2010 were collected. The patients were randomly divided into two groups with 80 patients (160 eyes) in each group. The patients in group A underwent the small-incision choper ECCE surgery with non-conjunctival flaps; while the patients in group B underwent the traditional conjunctival flaps. Then the total effective rate, incidence of complications, and satisfaction rate of the two groups were analyzed and compared. Results One month after the surgery, the comfort was found in 154 eyes (96.25%) in group A and in 141 eyes (88.13%) in group B; the difference was significant (χ2=7.332，Plt;0.05). The complications after the surgery including conjunctiva retraction, nutation, and huge scar were found in 7 eyes (4.38%) in group A and in 29 eyes (18.13%) in group B, and the difference was significant (χ2=15.149，Plt;0.01) . The visual acuity of the patients one day, one week and one month after the surgery in the two groups were: one day: 120 eyes (75.00%) in group A and 128 eyes (80.00%) in group B (χ2=1.467，Pgt;0.05); one week: 130 eyes (81.25%) in group A and 132 eyes (82.25%) in group B (χ2=0.084，Pgt;0.05); one month: 138 eyes (86.25%) in group A and 139 eyes (86.86%) in group B (χ2=0.027，Pgt;0.05). The cornea edema was alleviated half month after the surgery. Conclusion Compared with the traditional way, non-conjunctival flaps ECCE may save the surgical time, reduce the damage of the ocular surface, improve the visual acuity and received higher satisfaction rate and less conjunctive complication, which is a good surgical method in local hospital.
ObjectiveTo study the distribution of bone-specific alkaline phosphatase (BALP), type Ⅰ collagen cross-linked C-telopeptide (CTX) and tartrate-resistant acid phosphatase (TRAP)-5b in plateau area builders, and analyze the influencing factors under plateau environment. MethodsBetween April and May, 2014, using random stratified cluster sampling, we included in our study 650 blood samples from the power grid construction people in Batang County of Ganzi Autonomous Prefecture of Sichuan Province and Mangkang County of Tibet Autonomous Region with an altitude ranging from 2 600 to 4 450 meters, averaging (3 586.50±610.85) meters. We collected their fasting blood and detected their TRAP-5b, CTX and BALP by enzyme-linked immunosorbent assay method. By using SPSS 13.0, we analyzed the relationship between TRAP-5b, CTX, BALP and the influencing factors such as age, working intensity, residence time in the plateau area and altitude of the plateau. In the end, we tried to find out the main influencing factors of bone metabolic markers in the plateau environment.ResultsThe levels of CTX, BALP and TRAP-5b were the highest before the age of 20, and the average levels of them were respectively (1.04±0.38) ng/mL, (52.09±14.62) μg/L, and (4.22±1.38) U/L. With the increase of age, the levels of CTX, TRAP-5b and BALP showed a downward trend, but CTX and BALP reached the lowest level in the age group of 40 to 49 years old, and the average levels of CTX and BALP were (0.44±0.26) ng/mL and (24.77±9.89) μg/L, respectively. Then they gradually increased after the age of 50. TRAP-5b reached the lowest level in the age group of 30 to 39 years old, and the average level of TRAP-5b was (2.59±0.95) U/L. Then it gradually increased after the age of 40. The activity of CTX and BALP increased obviously with the increase of altitude. With the increase of labor intensity, BALP, TRAP-5b and CTX all increased. However, no matter what labor intensity, the bone formation marker BALP first increased and then decreased with the plateau residence time, while the bone absorption marker TRAP-5b increased after the first reduction.ConclusionsBone metabolic markers are different in different age groups. Altitude, working intensity and plateau working time have significant effects on bone metabolism markers.
