355例上斜肌麻痹的临床分析  

Clinical analysis of 355 patients with superior oblique palsy

作　　者：汪泽[1] 孟令勇 张利光[1] 李世洋[1] 王殿义[1] 孙丙池[1] 

机构地区：[1]山东兖州解放军91医院眼科,272100 [2]哈尔滨市穆斯林医院眼科

出　　处：《中国斜视与小儿眼科杂志》2003年第2期66-69,53,共5页Chinese Journal of Strabismus & Pediatric Ophthalmology

摘　　要：目的　探讨上斜肌麻痹 (superiorobliquepalsy ,SOP)的发病情况、分类、临床表现、常用检查方法的应用价值及手术选择的基本原则。方法　系统分析 1 4年间收治的 3 5 5例SOP病例。结果在各类麻痹性斜视 60 1例中 3 5 5例 (5 9 1 % )为SOP。先天性和后天性分别为 2 93例 (82 5 % )和 62例 (1 7 5 % )。双侧病变 90例 (2 5 4% )。 3 1 9例 (89 9% )归属于Knapp的分类标准。先天性SOP和后天性SOP有代偿头位者分别为 :1 60 / 2 93例 (5 4 6% )和 47/ 62例 (75 8% ) ,P <0 0 1 ;合并水平斜视者分别为 :1 90 / 2 93例 (64 8% )和 2 0 / 62例 (3 2 3 % ) ,P <0 0 0 1 ;先天性SOP 1 1 0 / 2 0 8例(5 2 9% )继发弱视。有同时视者 ,先天性 1 1 4/ 2 0 2例 (5 6 4% ) ,后天性 2 3 / 2 3例 (1 0 0 0 % ) ,P <0 0 0 1 ;有融合功能者 ,先天性 66/ 1 5 7例 (4 2 0 % ) ,后天性 2 0 / 2 0例 (1 0 0 0 % ) ,P <0 0 0 1 ;有远立体视者分别为 :41 / 1 48例 (2 7 7% )和 1 3 / 1 8例 (72 2 % ) ,P <0 0 0 1 ;有近立体视者分别为 :1 9/ 1 46例 (1 3 0 % )和 3 / 1 6例 (1 8 8% ) ,P >0 0 5。 92 8%先天性SOP眼有下斜肌亢进。 82 5 %后天性SOP者有明显自觉复视。自觉外旋斜视检出率为 46 2 % (先天性者检出?Objective To study the classification, clinical character of superior oblique palsy (SOP), to evaluate the applied value of several examinations and to describe the general principle of surgery in a large number of patients with SOP. Methods Clinical data of 355 patients with SOP who were examined and treated during the past 14 years were systematically analysed. Results Among the 601 patients with various paralytic strabismus, 355(59.1%) patients suffered from SOP and 319(89.9%) patients belonged to 7 classes proposed by Knapp and Moore. Of the 355 patients, 293 cases (82.5%) had a congenital onset, 62 cases (17.5%) had an acquired onset and 90 cases (25.4%) had a bilateral involvement. The presentations and the results of several examinations in the patients with congenital SOP and acquired SOP were respectively as follows: compensatory head posture: 160/293 cases (54.6%), 47/62 cases (75.8%); horizontal strabismus accompanying SOP: 190/293 cases (64.8%), 20/62 cases (32.3%); amblyopia: 110/208 cases (52.6%), 0/62 cases; simultaneous perception: 114/202 cases (56.4%), 23/23 cases (100.0%); fusion: 66/157 cases (42.0%), 20/20 cases (100.0%); distance stereoacuity: 41/148 cases (27.7%), 13/18 cases (72.2%); near stereoacuity: 19/146 cases (13.0%), 3/16 cases (18.8%). Inferior oblique overaction occurred in 92.8% of the eyes with congenital SOP. 82.5% of patients with acquired SOP complained of diplopia. Subjective extorsion was found in 46.2% of the patients (congenital SOP: 39.4%; acquired SOP: 71.4%. Valuable results were obtained in 89.3% of the patients who were examined with synoptophore, 51 patients with acquired SOP who complained of diplopia were definitively diagnosed by diplopia test with red and green glasses. Conclusion SOP is the most common form of paralytic strabismus. The patients with congenital SOP have a more impaired binocular vision than the patients with acquired SOP, but both groups of the patients have a severely impaired near stereoacuity. Synoptophore examination is the most valuable

关 键 词：上斜肌麻痹 临床分析 斜视 诊断 治疗 

分 类 号：R777.4[医药卫生—眼科]