探讨头盔式眼球运动训练系统在眼眶骨折术后患者康复训练中的应用效果。

收集2018年4月至2018年12月在首都医科大学附属北京同仁医院眼科中心行眼眶骨折修复术的患者40例(40只眼)。其中，男性25例(25只眼)，女性15例(15只眼)，年龄7~55岁，平均(26.4±12.8)岁。术后采用头盔式眼球运动训练系统进行康复训练。检查并记录患者术后1周、术后1个月及术后3个月的眼位、斜视度、静态立体视觉及动态立体视觉。以例数(眼数)和百分比进行描述。采用混合效应模型比较不同时间点的斜视度；采用广义线性混合效应模型比较不同时间点的眼位偏斜率、静态立体视觉及动态立体视觉。

本研究40例(40只眼)患者中眶下壁骨折者12例(12只眼)，眶内壁骨折者6例(6只眼)，眶内下壁骨折者19例(19只眼)，眶外下壁骨折者1例(1只眼)，多发性骨折者2例(2只眼)。术后1周，眼位偏斜者有22例(22只眼)，占57.89%；术后1个月，眼位偏斜者有12例(12只眼)，占35.29%；术后3个月，眼位偏斜者有3例(3只眼)，占9.68%。术后各时间点患者眼位的偏斜率经广义线性混合效应模型比较，水平偏斜率、垂直偏斜率以及水平合并垂直偏斜率随时间变化均逐渐降低，其差异均有统计学意义(χ²＝6.20，6.21，3.24；P<0.05)。水平偏斜组内进一步两两比较，术后1周与术后3个月比较，术后1个月与术后3个月比较，其差异均有统计学意义(χ²＝3.52，2.06；P<0.05)。垂直偏斜组内进一步两两比较，术后1周与术后1个月及术后3个月比较，其差异均有统计学意义(χ²＝2.32，3.42；P<0.05)。水平合并垂直偏斜组内进一步两两比较，术后1周与术后3个月比较，其差异有统计学意义(χ²＝2.49，P<0.05)。水平斜视度在术后1周、术后1个月及术后3个月分别为(1.92±2.73)△、(1.29±2.24)△及(0.23±0.72)△。垂直斜视度在术后1周、术后1个月及术后3个月分别为(2.61±4.22)△、(0.74±1.76)△及(0.10±0.40)△。经混合效应模型比较，水平与垂直斜视度均随时间变化逐渐下降，其差异均有统计学意义(F＝5.41，7.83；P<0.05)。水平斜视度与垂直斜视度术后1周与1个月和3个月比较，差异均有统计学意义(t＝-3.28，2.01，2.86，3.74；P<0.05)。术后1周，具备静态立体视觉功能的患者22例(22只眼)，占56.41%；术后1个月，具备静态立体视觉功能的患者30例(30只眼)，占81.08%；术后3个月，具备静态立体视觉功能的患者有34例(34只眼)，占91.89%。经广义线性混合效应模型比较，具备静态立体视觉功能的患者均随时间变化逐渐增加，其差异有统计学意义(F＝7.71，P<0.05)。术后1周与术后1个月及术后3个月比较，其差异均有统计学意义(t＝-2.66，3.82；P<0.05)。术后1周，具备动态立体视觉功能的患者有29例(29只眼)，占74.36%；术后1个月，具备动态立体视觉功能的患者有34例(34只眼)，占91.89%；术后3个月，具备动态立体视觉功能的患者有36例(36只眼)，占97.30%。经广义线性混合效应模型比较，具备动态立体视觉功能的患者均随时间变化逐渐增加，其差异有统计学意义(F＝5.42，P<0.05)。术后1周与1个月及3个月比较，其差异均有统计学意义(t＝-2.40，-3.14；P<0.05)。

眼眶骨折术后患者应用头盔式眼球运动训练系统进行康复训练，可以减少患者眼位偏斜度，助其恢复立体视觉，提高双眼视觉质量。

The aim of this study was to explore the effect of helmet eye movement training system in eye position and stereo vision rehabilitation of postoperative patients with orbital fracture.

A total of 40 patients (40 eyes) who underwent orbital fracture repair surgery in the Beijing Tongren Eye Center of Beijing Tongren Hospital affiliated to Capital Medical University from April to December 2018 were collected. There were 25 males (25 eyes) and 15 females (15 eyes). The age ranged from 7 to 55 years-old, with an average of (26.4±2.8) years-old. After operation, the helmet display equipment combined with the relevant visual perception biological model was used for eye movement, binocular integration and fixation stability rehabilitation training. The eye position, strabismus and static/dynamic stereoscopic vision were recorded after operation for 1 week, 1 month and 3 months. The mixed effect model was used to compare the changes of strabismus degree at different time points, and the generalized linear mixed effect model was used to compare the eye position deviation slope and static/dynamic stereo vision changes at different time points.

Among of 40 cases (40 eyes), there were 12 cases (12 eyes) of inferior orbital wall fracture, 6 cases (6 eyes) of medial orbital wall fracture, 19 cases (19 eyes) of medial inferior orbital wall fracture, 1 case (1 eye) of external inferior orbital wall fracture and 2 cases (2 eyes) of multiple fracture. One week after operation, there were 22 patients (22 eyes) with ocular deviation, accounting for 57.89%. One month after operation, there were 12 cases (12 eyes) with ocular deviation, accounting for 35.29%. Three months after operation, there were 3 cases (3 eyes) of eye position deviation, accounting for 9.68%. Compared with the generalized linear mixed effect model at each time point after operation, the horizontal deviation, vertical deviation and horizontal combined vertical deviation decreased gradually with time with the statistically significant difference between them (χ²=6.20, 6.21, 3.24; P<0.05). Further pairwise comparison of horizontal deviation group showed that there was significant difference between 1 week and 3 months after operation, 1 month and 3 months after operation (χ²=3.52, 2.06; P<0.05). Further pairwise comparison of vertical deviation group showed that there were significant differences between 1 week, 1 month and 3 months after operation (χ²=2.32, 3.42; P<0.05) . Further pairwise comparison of horizontal with vertical deviation group showed that there was significant difference between 1 week and 3 months after operation (χ²=2.49, P<0.05) . The degree of horizontal strabismus after operation for 1 week, 1 month and 3 months was (1.92±2.73)△, (1.29±2.24)△, (0.23±0.72)△, respectively. The degree of vertical strabismus after operation for 1 week, 1 month and 3 months was (2.61±4.22)△ , (0.74±1.76)△, (0.10±0.40)△, respectively. Compared with the mixed effect model, the degree of horizontal/vertical strabismus decreased gradually with time with the statistically significant difference between them (F=5.41, 7.83; P<0.05). There were significant differences in the degree of horizontal/vertical strabismus among 1 week, 1 month and 3 months after operation (t=-3, 28, 2.01, 2.86, 3.74; P<0.05). One week after operation, there were 22 patients (22 eyes) with positive static stereoscopic vision, accounting for 56.41%. One month after operation, there were 30 patients (30 eyes) with positive static stereoscopic vision, accounting for 81.08%. Three months after operation, there were 34 patients (34 eyes) with positive static stereoscopic vision, accounting for 91.89%.Compared with the generalized linear mixed effect model, the positive rate of static stereo vision gradually increased with time, and the difference was statistically significant (F=7.71, P<0.05). There were significant differences between 1 week and 1 month and 3 months after operation (t=-2.66, 3.82; P<0.05). One week after operation, dynamic stereoscopic vision passed through 29 patients (29 eyes), accounting for 74.36%. One month after operation, dynamic stereoscopic vision passed through 34 patients (34 eyes), accounting for 91.89%. Three months after operation, dynamic stereoscopic vision passed through 36 patients (36 eyes), accounting for 97.30%. Compared with the generalized linear mixed effect model, the passing rate of dynamic stereo vision gradually increased with time with the statistically significant difference between them (F=5.42, P<0.05). There were significant differences among 1 week, 1 month and 3 months after operation (t=-2.40, -3.14; P<0.05).

The application of helmet eye movement training system for rehabilitation training in postoperative patients with orbital fracture can reduce the degree of eye position deviation, help to restore stereoscopic vision and improve the quality of binocular vision.