先天性斜肌功能障碍的临床特征分析  

Clinical characteristics analysis of congenital oblique muscle disorders

作　　者：盛迅伦 雷洁琼 马鸿娟 任英华 张金金 

机构地区：[1]宁夏眼科医院,宁夏银川750001

出　　处：《宁夏医学杂志》2013年第6期499-501,共3页Ningxia Medical Journal

摘　　要：目的探讨先天性斜肌功能障碍的临床特征及鉴别诊断要点。方法收集就诊于宁夏眼科医院的先天性斜肌功能障碍的门诊病例,均详细询问病史,进行视力、验光、头位、眼位、Bielschowsky歪头试验、眼底照相和双眼视功能检查,通过全面的临床资料分析,确定诊断。结果 25例先天性斜肌功能障碍病例中内转时上斜视20例,内转时下斜视3例,上斜肌腱鞘综合征2例。内转时上斜视病例中原发性下斜肌功能亢进者18例,占90.0%;先天性滑车神经麻痹继发下斜肌功能亢进2例。原发性下斜肌功能亢进伴斜视10例,占55.6%。其中V型外斜视6例,V型内斜视4例。不伴有水平斜视的8例中有4例下斜肌功能亢进失代偿,出现复视,误诊为后天性滑车神经麻痹。内转时下斜视3例,其中先天性下斜肌麻痹,继发上斜肌功能亢进(内斜A征)2例,原发性上斜肌功能亢进(外斜A征)1例。上斜肌腱鞘综合征2例,均表现Y征。结论先天性斜肌功能障碍常与水平斜视同时存在。先天性斜肌功能障碍病例中,以原发性上斜肌功能过强最常见,其典型的临床表现为内转眼表现为上斜视,无先天性滑车神经麻痹的体征。原发性上斜肌功能过强失代偿时,容易误诊为后天性滑车神经麻痹。Objective Study the clinical characteristics of congenital oblique muscle disorders and the essential of differential diagnosis. Methods Patients with congenital oblique muscle disorders, were enrolled in this study from August 2011 to December 2012. The medical history was recorded and the visual acuity, manifest refraction, head position, ocular alignment, Bielschowsky Head Tilt Test and binocular function were measured,together with taking fundus photograph. The diagnosis was made following the analysis of the clinical data. Results The study was conducted 25 patients with congenital oblique muscle disorder, including 20 patients with up - shoot of eye in adduction, three patients with down - shoot of eye in adduction, two patients with Brown＇ s Syndrome. Among 20 patients with up - shoot of eye in adduction,primary inferior oblique muscle overaction （IOOA） occurred in 18 （90.0%） patients and secondary IOOA occurred in two patients with congenital trochlear palsy. Ten patients with primary IOOA had strabismus, six with V - pattern exo- tropia and four with V - pattern esotropia. Among eight patients without horizontal deviations in primary position, four had diplopia due to decompensated function of IOOA, which had been misdiagnosed as acquired trochlear palsy. Among 3 patients with down - shoot of eye in adduction, two with congenital inferior oblique muscle palsy and secondary superior oblique muscle overaction （SOOA） showed A -pat- tern esotropia and 1 with primary IOOA showed A - pattern exotropia. Two patients with Brown＇ s Syndrome showed Y - pattern exotropi- a, characterized by restricted elevation in adduction. Conclusion The congenital oblique muscle disorders often occurs in horizontal de- viation. In this study, the most common cause in the congenital oblique muscle disorders is the primary IOOA which is characterized by up - shoot of eye in adduction without any signs of congenital trochlear palsy. When the primary IOOA decompensate, it is likely to diagnosis as acquired trochlear

关 键 词：先天性 斜视 下斜肌功能过强 上斜肌功能过强 Brown综合征 

分 类 号：R779.6[医药卫生—眼科]