目的探讨扭动模式超声乳化白内障吸除术的有效性和安全性。设计病例系列研究。研究对象年龄相关性白内障患者印例(87眼)。方法按就诊顺序登记并按随机表法将患者分为2组,扭动模式组43眼、传统模式组44眼,分别在2.2 mm微切口下使用扭动模式与传统模式进行超声乳化白内障吸除手术。手术中记录两种术式有效超声能量和平均超声时间,术后随访时检查患眼的最佳矫正视力,观察角膜内皮细胞及角膜水肿程度。主要指标有效超声能量、平均超声时间、角膜内皮细胞丢失率、角膜水肿程度及最佳矫正远视力等。结果有效超声能量,扭动模式组乳化各级核分别为Ⅱ级(3.03±0.64)%、Ⅲ级(7.47±2.00)%、Ⅳ-Ⅴ级(17.06±3.32)%,传统模式组分别为Ⅱ级(4.29±0.94)%、Ⅲ级(9.29±3.64)%、Ⅳ-Ⅴ级(19.78±1.66)%,两组之间比较差异均有统计学意义(P均<0.05)。平均超声时间,乳化吸除Ⅱ级核扭动模式组[(10.95±4.28)秒]少于传统模式组[(14.93±4.29)秒](P=0.019);而Ⅲ级及Ⅳ-Ⅴ级核两组无明显差异(P均>0.05)。角膜水肿程度,术后1天扭动模式组为0级34眼(79.0%)、+级6眼(14.0%)、++级3眼(7.0%),传统模式组为0级24眼(54.5%)、+级15眼(34.1%)、++级5眼(11.4%),两组比较差异有统计学意义(P=0.041);而术后7天两组之间无明显差异(P=0.281);术后1个月及3个月两组均无角膜水肿患者。术后1个月及3个月角膜内皮细胞丢失率,扭动模式组1个月为(6.39±0.90)%、3个月(6.54±1.24)%;传统模式组1个月为(13.17±1.78)%、3个月(13.67±2.36)%,两组之间比较差异均有统计学意义(P均<0.05)。术后最佳矫正视力≥0.5者,扭动模式组为1天31眼(72.1%)、7天35眼(81.4%),传统模式组为1天19眼(43.2%)、7天27眼(61.4%),两组比较差异均有统计学意义(P均<0.05),而术后1个月及3个月两组无明显差异(P均>0.05)。结论扭动模式超声乳化白内障吸除术是一种高效安全的超声乳化模式,较传统模式乳化能量明显减少,并明显减轻对患者角膜内皮细胞损伤。(眼科,2008,17:82-85) Objective To investigate the effectiveness and safety of twist mode phacoemulsification. Design case series research. Age-related cataract patients were printed (87 eyes). Methods The patients were divided into two groups according to the sequence of visits and randomly divided into two groups: 43 eyes in the twist mode group and 44 eyes in the traditional mode group. Twisted mode and traditional mode were used respectively to perform phacoemulsification surgery. During the operation, the effective ultrasonic energy and average ultrasonic time of two kinds of surgical procedures were recorded. The best corrected visual acuity of eyes was observed after operation, and the corneal endothelial cells and corneal edema degree were observed. The main indicators of effective ultrasonic energy, the average ultrasound time, the rate of loss of corneal endothelial cells, corneal edema and the best corrected distance vision and so on. Results The effective ultrasonic energy and torsional mode group were grade Ⅱ (3.03 ± 0.64)%, grade Ⅲ (7.47 ± 2.00)% and grade Ⅳ-Ⅴ (17.06 ± 3.32)%, respectively. The traditional model group was Ⅱ Grade (4.29 ± 0.94)%, grade Ⅲ (9.29 ± 3.64)%, grade Ⅳ-Ⅴ (19.78 ± 1.66)% respectively. There was significant difference between the two groups (all P <0.05). The average time of ultrasound, emulsified aspiration grade Ⅱ nuclear torsion mode group [(10.95 ± 4.28) s] was less than that of the traditional model group [(14.93 ± 4.29) s] (P = 0.019) There was no significant difference between the two groups (P> 0.05). The degree of corneal edema was 0 grade 34 (79.0%), grade 6 (14.0%) and ++ grade 3 eyes (7.0%) on day 1 postoperatively in twist mode group and 0 grade 24 54.5%), grade 15 (34.1%) and grade 5 (11.4%). The difference between the two groups was statistically significant (P = 0.041), while there was no significant difference between the two groups P = 0.281). There was no corneal edema in both groups at 1 month and 3 months after operation. The loss rate of corneal endothelial cells at 1 month and 3 months after operation was (6.39 ± 0.90)% for 3 months and 6.54 ± 1.24% for 3 months (writhing mode) 1.78)%, 3 months (13.67 ± 2.36)% respectively. There was significant difference between the two groups (all P <0.05). The best corrected visual acuity of ≥ 0.5 in the control group was 31 eyes (72.1%) in 1 day, 35 eyes (81.4%) in 7 days, 19 eyes (43.2%) in 1 day, 27 eyes (61.4%). There was significant difference between the two groups (P <0.05), but there was no significant difference between the two groups at 1 month and 3 months postoperatively (all P> 0.05). Conclusion Twist mode phacoemulsification is a safe and effective phacoemulsification model, which can significantly reduce the energy of emulsification and significantly reduce the damage of corneal endothelial cells. (Ophthalmology, 2008, 17: 82-85)