사시수술 중 직근절제시 근육훅의 견인으로 인한 수술양의 오차 - 제1보
The Change of Rectus Muscle Length Caused by Traction With Muscle Hooks in Strabismus Surgery–the First Report
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목적: 사시수술 중 직근절제시 두개의 사시갈고리로 근육을 당김으로 인해 근육의 길이가 유의하게 변하는지 알아보고자 하였다. 대상과 방법: 두 병원(A, B병원)에서 외안근 중 직근 절제술을 시행 받는 환자를 대상으로 하였으며 직근 박리 후 사시갈고리로 근육의부착 부위를 걸고 측경기(caliper)로 절제양을 Gentian violet으로 근육에 표시하였다. 두번째 사시갈고리를 근육의 기시부로 걸어 당긴후 표시해 놓은 절제양을 다시 측정하였다. 두 번째 사시갈고리로 견인하기 전, 후 근육의 길이가 유의하게 늘어났는지와 이러한 변화에 영향을 미치는 인자가 있는지 분석하였다. 결과: 총 42명, 44개 직근 중 25개의 직근에서 길이변화가 없었다. 13개 직근에서 0.5 mm, 6개 직근에서 1 mm까지 늘어났으며 1mm 보다 많이 증가한 경우는 없었다. 전체 평균 0.27 mm 늘어났으며 병원별로는 A병원은 27개 직근 중 15개, B병원은 17개 중 4개의직근에서 0.5 mm이상 늘어나 두 병원간 유의한 차이를 보였다(P=0.037). 그 외에 성별, 나이, 진단명, 수술한 근육, 계획한 절제양에따른 유의한 차이는 없었다. 결론: 직근 절제술시 두 개의 사시갈고리로 근육을 당기는 것은 25예(56.8%)에서 근육의 길이에 변화가 없었으며 19예(43.2%)에서0.5~1.0 mm 근육의 길이를 늘여 절제양의 오차를 발생시킬 수 있음을 알 수 있다. 이러한 오차는 특히 수술자나 보조자의 성향에따라 다르게 나타날 수 있는 것으로 생각된다.
Abstract
Purpose: To evaluate changes in muscle length when retracting the extraocular rectus muscle with muscle hooks during strabismus surgery. Methods: Forty-four rectus muscles of 42 patients consecutively resected in two hospitals (A, B) were included in this study. After isolation of the rectus muscle, the length of the muscle was recorded and the portion to be resected was marked using gentian violet stain on the tip of calipers. After the rectus muscle was retracted with two muscle hooks in either direction, its length was measured again with the calipers. Results: The length of the rectus muscle was not changed by retraction in 25 of 44 muscles (56.8%). The length of the muscle was changed by 0.5 mm in 13 muscles (29.5%) and by 1mm in six muscles (13.6%). Changes of rectus muscle length over 0.5mm were observed in 15 of 27 muscles of patients treated at hospital A (55.5%) and four of 17 muscles of patients treated at hospital B (23.5%). The results for the two hospitals were significantly different (p=0.037). Conclusions: Small errors in measurement can occur when muscle resections are performed during strabismus surgery. Institutional or clinician related factors may explain variations in error rates between hospitals.
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