摘要：
Objective To summarize the clinical features and classification,and establish the corresponding surgical methods.Methods A noncomparative interventional case series collected 41 cases.Children patients with diagnosis of bilateral asymmetric superior oblique palsy were included in this study,and received surgical treatment from January 2010 to January 2016 in Guangzhou women and children's Medical Center.Follow-up was in 2 weeks,1 month,and half a year.Postoperative loss contact cases were excluded.This topic summarized characteristics through clinical manifestations.Varied surgical methods for types of patients were used,postoperative results were analyzed,and the applicability of various methods of surgery was assessed.Results According to the clinical features the patients were divided into four types,and with varied surgical methods.Type Ⅰ:preoperative obvious vertical eye position,compensatory head position and "V" sign in 1 case,did partial excision of the inferior oblique muscle in the eye with hyperthyroidism.It attained normal ocular alignment in primary position.Type Ⅱ:preoperative obvious vertical eye position and "V" sign,no compensatory head posture of 20 patients with hyperthyroidism eyes did a partial excision of the inferior oblique muscle surgery.All attained normal ocular alignment in primary position.Type Ⅲ:preoperative vertical eye position and compensatory head position was not obvious,but with "V" sign was 12 cases,inferior oblique part underwent binocular symmetric resection.All attained normal ocular alignment in primary position,and had no compensatory head posture,only 1 case had a level undercorrection.Type Ⅳ:preoperative vertical eye position,compensatory head position,and "V" sign was not obvious in 8 cases,only horizontal direction strabismus surgery.All attained normal ocular alignment in primary position,and there was no compensatory head position.Conclusions Pediatric with non-symmetry superior oblique paralysis can be divided imp several types according to their clinical features.By using different operation methods,operation can obtain satisfactory results.%目的 儿童双眼非对称性上斜肌麻痹是一种较为复杂的斜视类型,并多合并水平斜视.该类病人在儿童时期的手术都具有比较大的难度.文中总结其临床特征及分型,研究制定相应的手术方式.方法 采用非对照干预性病例研究方法(Noncomparative interventional case series).纳入研究对象为2010年1月至2016年1月期间,在广州市妇女儿童医疗中心,诊断为双眼非对称性上斜肌麻痹并且接受了手术治疗儿童.分别在术后2周、1个月、半年复诊.术后失访病例已排除.本课题通过病人临床表现,归纳出其临床特征,并制定适合儿童的双眼非对称性上斜肌麻痹分型方法.对不同类型的病人采用不同的手术方法,通过分析术后效果,评估各种手术方法的适用性.结果 收集双眼非对称性上斜肌麻痹斜视病人资料共41例.病人根据临床特征可分为四种类型,使用不同的手术方式:Ⅰ型:术前有明显垂直眼位、代偿头位和“V征”病人1例,做较亢进的一只眼下斜肌部分切除联合水平斜视矫正术,术后第一眼位双眼正位.Ⅱ型:术前有明显垂直眼位和“V征”,无代偿头位病人20例,做较亢进的一只眼下斜肌部分切除联合水平斜视矫正术,术后第一眼位双眼正位.Ⅲ型:术前垂直眼位和代偿头位不明显,但“V”征表现明显患者12例,行双眼对称的下斜肌部分切除术联合水平斜视矫正术,术后第一眼位无垂直眼位,也无代偿头位,仅1例术后水平眼位欠矫.Ⅳ型:术前垂直眼位和代偿头位不明显,“V”征表现不明显8例,仅行水平方向斜视手术,术后第一眼位正位,无代偿头位.结论 对于儿童非对称性上斜肌麻痹斜视病人,根据其临床特征可以分为几种类型.不同类型的儿童非对称性上斜肌麻痹斜视病人,通过采用不同的手术方案,可以获得满意的手术效果.
