正确理解Bielschowsky歪头试验在上斜肌麻痹鉴别诊断中的意义

Significance of accurately interpreting the Bielschowsky tilt test in the differential diagnosis of superior oblique muscle paralysis

上斜肌麻痹是临床常见的一种垂直旋转性斜视类型,分型较多,不论哪种类型的上斜肌麻痹,Bielschowsky试验在其诊断中均有重要作用,往往被认为是诊断和鉴别诊断的重要标准。但Bielschowsky试验对于诊断上斜肌麻痹的敏感度和特异度并非100%,这是因为Bielschowsky试验的产生机制并非单纯的眼外肌运动不平衡,还涉及前庭和中枢的反射通路,因而累及到相应部位的病变,都有可能产生Bielschowsky试验阳性的结果。而一些前庭和中枢的病变亦有可能引发斜视,所以Bielschowsky试验阳性和上斜肌麻痹并非一一对应关系,正确解读Bielschowsky试验在上斜肌麻痹中的作用对于临床工作的开展与相应疾病的治疗具有重要意义。

Superior oblique muscle paralysis is a common type of vertical rotatory strabismus with various subtypes.Regardless of the subtype,the Bielschowsky tilt test plays a crucial role in the diagnosis of superior oblique muscle paralysis and is often considered a significant criterion for diagnosis and differential diagnosis.However,the sensitivity and specificity of the Bielschowsky tilt test for diagnosing superior oblique muscle paralysis are not 100%due to the mechanism involved.The test is not solely based on extraocular muscle imbalance but also involves reflex pathways of the vestibular system and central nervous system.Consequently,lesions affecting corresponding areas may yield positive results in the Bielschowsky tilt test.Additionally,vestibular and central nervous system lesions can also cause strabismus,leading to a lack of one-to-one correspondence between a positive Bielschowsky tilt test and superior oblique muscle paralysis.Therefore,correctly interpreting the role of the Bielschowsky tilt test in superior oblique muscle paralysis is of paramount importance for the effective clinical management and treatment of associated conditions.