先天性上斜肌麻痹的上斜肌Guyton增强牵拉试验和眼球旋转牵拉试验特征  

Characteristics of Guyton′s exaggerated forced duction test(FDT)and torsional FDT in congenital superior oblique palsy

作　　者：李月平 陈红芮 顾诗宇 丁娟[1] 张伟[1] 赵堪兴[1] Yueping Li;Hongrui Chen;Shiyu Gu;Juan Ding;Wei Zhang;Kanxing Zhao(Tianjin Eye Hospital,Nankai University Affiliated Eye Hospital,Clinical College of Ophthalmology of Tianjin Medical University,Tianjin Eye Institute,Tianjin Key Laboratory of Ophthalmology and Visual Science,Tianjin 300020,China;Department of Ophthalmology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]天津市眼科医院、南开大学附属眼科医院、天津医科大学眼科临床学院、天津市眼科研究所、天津市眼科学与视觉科学重点实验室,天津300020 [2]郑州大学第一附属医院眼科,郑州450052

出　　处：《中华眼科杂志》2023年第7期535-541,共7页Chinese Journal of Ophthalmology

基　　金：天津市医学重点学科(专科)建设项目(TJYXZDXK-016A);天津市自然科学基金(21JCYBJC01860);天津市卫生健康委员会科技项目(ZC20187);南开大学眼科研究院项目(NKYKK202201)。

摘　　要：目的探讨先天性上斜肌麻痹(CSOP)患者上斜肌Guyton增强牵拉试验(FDT)和眼球旋转FDT的特征其与患者临床特征的相关性。方法横断面研究。纳入2021年9月至2022年3月于天津市眼科医院拟行斜视矫正手术的单眼CSOP患者和间歇性外斜视(IXT)患者。术前测量患者双眼黄斑中心凹-视盘几何中心夹角(FDA)及上斜肌最大横截面积(max-CSA)术中双眼行Guyton增强FDT和旋转FDT,对上斜肌松弛程度进行评价和比较。分析两种FDT的特征及其与垂直斜视度数、FDA、max-CSA的相关性。采用t检验、ANOVA检验、Tukey、Mann-WhitneyU检验和χ2检验进行统计学分析。结果纳入患者共42例(84只眼),其中IXT患者19例(38只眼),男10例,女9例,年龄7(7,8)岁;CSOP患者23例(46只眼,麻痹眼和非麻痹眼各23只眼),男13例,女10例,年龄8(4,8)岁。IXT和CSOP患者性别构成和年龄差异均无统计学意义(均P>0.05)。Guyton增强FDT测得CSOP患者麻痹眼、非麻痹眼和IXT患者双眼上斜肌松弛程度分别为(-2.52±1.20)、(-0.35±0.71)和(-0.03±0.16)级,差异有统计学意义(F=88.10,P<0.001)。旋转FDT测得CSOP患者麻痹眼、非麻痹眼和IXT患者双眼的眼球外旋角度分别为48.70°±9.67°、37.39°±5.40°和38.95°±2.88°,差异有统计学意义(F=16.67,P<0.001),内旋角度差异无统计学意义(F=2.36,P=0.100)。IXT患者与CSOP患者FDA分别为-12.11°±7.42°和-19.02°±4.95°,CSOP患者麻痹眼与非麻痹眼上斜肌max-CSA分别为(7.59±4.69)和(11.63±3.64)mm2,差异均有统计学意义(均P<0.001)。Guyton增强FDT测得上斜肌肌腱松弛程度分级与旋转FDT测得外旋角度呈负相关(r=-0.64,P=0.001),二者与上斜肌max-CSA分别呈正相关(r=0.45,P=0.030)和负相关(r=-0.52,P=0.011),但与垂直斜视度数(r=-0.12,P=0.579;r=0.33,P=0.126)和FDA(r=-0.02,P=0.921;r=-0.23,P=0.309)均无相关性。结论Guyton增强FDT和旋转FDT均可评价先天性上斜肌麻痹患者的上斜肌松弛程度,且二者与上斜肌形态Objective To investigate the characteristics of Guyton′s exaggerated forced duction test(FDT)and torsional FDT in patients with congenital superior oblique palsy(CSOP)and their correlation with clinical features.Methods This cross-sectional study included single-eye CSOP patients and intermittent exotropia(IXT)patients scheduled for strabismus correction surgery at Tianjin Eye Hospital from September 2021 to March 2022.Prior to surgery,measurements of fovea-disc angle(FDA)and maximum cross-sectional area of the superior oblique muscle(max-CSA)were obtained in both eyes of the patients.The Guyton′s exaggerated FDT and torsional FDT were performed intraoperatively to assess the degree of superior oblique muscle relaxation.The characteristics of the two FDT tests and their correlation with vertical strabismus angle,FDA,and max-CSA were analyzed.Statistical analyses were conducted using t-test,ANOVA,Tukey′s test,Mann-Whitney U test,and chi-square test.Results A total of 42 patients(84 eyes)were included in the study,including 19 IXT patients(38 eyes)and 23 CSOP patients(46 eyes,23 eyes with palsy and 23 eyes without palsy).There were no statistically significant differences in gender composition or age between the IXT and CSOP patients(all P>0.05).The degrees of superior oblique muscle relaxation measured by the Guyton′s exaggerated FDT were(-2.52±1.20),(-0.35±0.71),and(-0.03±0.16)for the palsy eye,non-palsy eye,and IXT eyes,respectively,showing significant differences(F=88.10,P<0.001).The torsional FDT measurements yielded external rotation angles of 48.70°±9.67°,37.39°±5.40°,and 38.95°±2.88°for the palsy eye,non-palsy eye,and IXT eyes,respectively,showing significant differences(F=16.67,P<0.001).There was no statistically significant difference in internal rotation angles(F=2.36,P=0.100).The FDA values were-12.11°±7.42°for IXT patients and-19.02°±4.95°for CSOP patients,while the max-CSA values for the palsy eye and non-palsy eye of CSOP patients were(7.59±4.69)mm²and(11.63±3.64)mm²,res

关 键 词：斜视 动眼肌 眼肌麻痹 眼球运动 眼外科手术 

分 类 号：R779.6[医药卫生—眼科]