方法：老年性白内障患者72例89眼(术后1mo随访视力均达到0.6及以上)，晶状体核硬度：Ⅲ级46眼，Ⅳ级及以上43眼(LOCS Ⅱ级标准分级)。按核级随机分成2组，均为同一位医师操作，采用stop-and-chop分核：A组使用扭动超声，Ⅲ级22眼(扭动能量80% IP on)、Ⅳ级及以上17眼(扭动能量100%IP on)； B组使用传统超声模式(连续线性模式)，Ⅲ级24眼(能量50%)，Ⅳ级及以上26眼(能量60%～70%)，行超声乳化白内障吸除联合后房型人工晶状体植入术。观察术中实际等效超声能量(TEP)，累计释放能量(CDE)，有效超声时间(EPT)； 比较两种模式在处理硬核白内障超声乳化术中有效性。

结果：Ⅲ级核处理：扭动超声组TEP显著高于传统超声组(24.58±7.78)% vs(13.84±1.97)%，扭动超声组EPT显著低于传统超声组(50.59±14.73)s vs(60.19±9.04)s，差异有统计学意义(P<0.05)； CDE两组差异无显著性(13.12±6.03)% vs(13.38±2.85)%。Ⅳ级及以上核处理：扭动超声组CDE(34.10±13.48)%与EPT(104.64±32.4)s均高于传统超声组CDE(30.31±13.48)%与EPT(93.01±41.01)s，但差异无统计学意义。术中针头阻塞：扭动组4/17例，传统组2/26例(χ²=2.16，P=0.14)。

结论：两种超声模式均能安全有效的处理常规及硬核白内障，扭动超声模式在处理Ⅲ级核中具有时间短、效率高的特点。随着核硬度的增加，传统超声在处理硬核、极硬核中仍具有效率较高、不堵塞的优势。根据不同核硬度选择超声模式可提高手术效率及安全性。

METHODS: A total of 89 eyes(72 patients)(visual acuity was of 0.6 and above after 1mo follow-up)of different nucleus density level(LOCS Ⅱ criteria grade Ⅲ 46 eyes, grade Ⅳ and more 43 eyes)were randomly assigned into 2 groups: ozil group(group A), grade Ⅲ 22 eyes(torsional energy 80% IP on); grade Ⅳ and more 17 eyes(torsional energy 100% IP on); Traditional mode group(group B), grade Ⅲ 24 eyes(energy 50%), grade Ⅳ and more 26 eyes(energy 60%～70%). All surgeries were performed by the same experienced surgeon,who use the chop to split the nucleus in the application of phacoemulsification. Intraoperative parameters were total equivalent pawer(TEP), cumulative dissipated energy(CDE)and effective phaco time(EPT)and surgical complications. The effectiveness of the two modes in dealing with hard-core cataract phacoemulsification were compared.

RESULTS: GradeⅢ nucleus dealing: TEP of ozil group was significantly higher than that of the traditional mode group \〖(24.58±7.78)% vs(13.84±1.97)%\〗and EPT of ozil group was significantly lower than that of the traditional mode group(50.59±14.73 s vs 60.19±9.04 s, P<0.05). CDE showed no difference between two groups \〖(13.12±6.03)% vs(13.38±2.85)\〗. Grade Ⅳ and more nucleus dealing: CDE \〖(34.10±13.48)%\〗 and EPT(104.64±32.4s)of the ozil group was higher than CDE \〖(30.31±13.48)%\〗 and EPT(93.01±41.01s)of the traditional mode group, but there were no difference between two groups. Obstacles in the needle of phacoemulsification surgery: ozil group 4/17, traditional mode group 2/26(χ²=2.16, P=0.14).

CONCLUSION: Bothozil and traditional mode can deal with all kinds of nucleus effectively and safely. Ozil mode is more efficacy and quick deal in grade Ⅲ nucleus. With the increase of nucleus hardness, the traditional mode still have the advantage of high efficiency and no obstacle to dealing patients with grade Ⅳ and more nucleus. Choose according to different nuclear hardness ultrasonic model can improve the operation efficiency and security.