双上斜肌麻痹的临床特征与治疗

THE DIAGNOSIS AND TREATMENT OF CONGENITAL BILATERAL SUPERIOR OBLIQUE PALSY

双眼上斜肌同时麻痹称为双上斜肌麻痹,近年来受到国内外眼科学者的重视。本文报告13例,均是我科近年来手术治疗并在术后观察3个月以上者。13例病人都无明显外伤史,发病在出生时及出生后早期,为先天性病变。手术次数1～2次。临床特征:不对称病变以单眼上斜视,代偿头位为主要表现,其中有一部分病人为潜在型双侧病变。对称型以两侧同向注视时的反向上斜视为主要表现,双侧Bielschowsky征为阳性。不少病人同时有V型斜视。需要手术治疗的病人一般应做双眼手术。可根据病情决定是同时做双侧手术,还是分次做,以及术式、术量。术后大部分病人能获得满意的头位及眼位。

13 patients with surgically treated congenital superior oblique palsy are presented. Follow-up ranged at least three months after surgery. Most patients received one operation, three cases re-quired the secondary operation. Clinical symptom, Asymmetrical palsies: anomalous head posturing; hypertropia in primary position. Symmetrical palsies; a right hypertropia in left gaze and left hypertropia in right gaze;a positive Bielschowsky test on tiltion the head toward either shoulder, many cases have'V'pattern. The patients who need operation should usually undergo bilateral surgery. The most patients obtained satisfactory results after surgery.