垂直扫视运动检查在上斜肌麻痹中的应用

Clinical application of vertical saccades in superior oblique palsy

目的建立不同年龄正常人垂直扫视运动峰速的参数;了解该检查的可重复性;研究上斜肌麻痹患者垂直扫视运动的峰速变化特点。方法采用运动EOG法检查22例正常人(青年组12例和中老年组10例)及18例上斜肌麻痹患者的垂直扫视运动峰速,正常人中10例在1周至1个月内重复本检查。结果正常人4个方位的平均峰速均较对称,各方位向上与向下运动、左右眼各相对应方向、中老年组与青年组相对应方向、重复性试验者前后两次检查相对应方向平均峰速差异均无统计学意义;上斜肌麻痹眼内下方向下运动平均峰速较向上运动平均峰速降低大约20%,而其余方位无明显差异。结论垂直扫视运动检查具有较好的可重复性和稳定性,可以用作上斜肌麻痹的定量检查。

Objective The way of conventional evaluation of superior oblique palsy mainly dependents on clinical examination. Vertical saccadic movements may provide a quantitative test to analysis the function of superior oblique. This study was to establish the peak velocity metrics of vertical saccades in normal subjects at different age groups and assess the stability and reproducibility of the vertical saccades by electrooculography （EOG）. Methods Vertical saccadic movements were recorded with EOG technique in 22 normal subjects and 18 patients with superior oblique palsy. The normal subjects were divided into young subjects （12） and ten elderly subjects （12） groups. The record was repeated in 10 normal subjects in 1 week to 1 month. Results Peak velocities of upward and downward movement were symmetrical for abduction and adduction in upper and lower fields of gaze. No significant differences were showed between upward and downward peak velocities in any fields of gazes. No significant differences were found in the mean peak velocities between the young group and that of the elder group in corresponding direction. In the repeat-recorded subjects, no significant differences were showed in the mean peak velocities between initial result and the second one in corresponding direction. Superior oblique palsy caused a 20% reduction in mean downward peak velocity compared with mean upward peak velocity in the lower field of gaze in 20° adduction. Significant differences were showed in the mean downward peak velocity between the paretic eyes and normal eyes in the lower field of gaze in 20° adduction. Conclusion The vertical saccade of EOG had a quite good stability and reproducibility, therefore it is a good examination tool of superior oblique palsy.