先天性上斜肌不全麻痹手术前后Bielschowsky歪头试验的变化

Postoperative change of the Bielschowsky head tilt test in patients with unilateral congenital superior oblique palsy

目的 探讨先天性上斜肌不全麻痹手术前、后Bielschowsky歪头试验的变化。 方法根据患眼原在位的垂直斜视度数 ,按照麻痹性斜视的手术原则 ,采用常规手术方式 ,减弱麻痹肌的直接拮抗肌和配偶肌 ,即减弱患眼的下斜肌和对侧眼的下直肌 ,治疗 38例单眼先天性上斜肌不全麻痹患者。手术前、后采用三棱镜遮盖法定量进行Bielschowsky歪头试验 ,检查患者原在位和头部向双侧倾斜时患眼的垂直斜视度数。以头部向患眼侧倾斜时患眼的垂直斜视度数高于头部向健眼侧倾斜时患眼的垂直斜视度数的数值≥ 5 0 △ 为Bielschowsky歪头试验阳性。结果 术前全部患眼的垂直斜视度数原在位为 3 0 △ ～ 2 5 0 △ ,平均为 11 0 △ ;头部向患眼侧倾斜时为 15 0 △ ～ 4 0 0 △ ,平均为 2 3 0 △ ;头部向健眼侧倾斜时为 0 0 △ ～ 10 0 △ ,平均为 2 5 △ ,Bielschowsky歪头试验均为阳性。术后全部患眼原在位的垂直斜视度数为 0 0 △ ～ 5 0 △ ,平均为 2 0 △ ;4例患者Bielschowsky歪头试验转为阴性 ,34例仍为阳性 (89 5 % )。结论 采用减弱患眼下斜肌和对侧眼下直肌方法治疗先天性上斜肌不全麻痹 ,术后患者Bielschowsky歪头试验的转阴率较低。以其作为手术疗效的评价标准值得探讨。

Objective To investigate the postoperative changes of the head tilt test in patients with unilateral congenial superior oblique palsy. Methods Thirty-eight cases with congenital unilateral superior oblique palsy underwent the ipsilateral inferior oblique or/and contralateral inferior rectus weakening procedure. Bielschowsky head tilt test was evaluated quantitatively before and after the operation by the prism cover test while the patient fixated at 33 cm and 6 m on the small light target. Α positive Bielschowsky head tilt test was defined as one in which the vertical deviation when the head tilt to the side of the paresis was at least 5.0 △ greater than that on tilt to the uninvolved side. Results Before the operation, the hyperdeviation of the involved eye was 3.0 △-25.0 △ (average 11.0 △) in primary position. The deviation on tilt to the side of the paresis was 23.0 △(15.0 △-40.0 △) and the deviation on tilt to the uninvolved side was 2.5 △ (0.0 △- 10.0 △). A positive Bielschowsky tilt test was found in all cases preoperatively. After the operation, the hyperdeviation of the involved eye was 0.0 △-5.0 △(average 2.0 △) in primary position. The result of Bielschowsky tilt test was still positive in 34 cases and negative in only 4 cases. Conclusion In most cases with unilateral superior oblique paresis, the results of Bielschowsky tilt test do not change to negative postoperatively. The significance of using this test for evaluating surgical results remains to be determined.