摘要目的 比较上斜肌加强术与下斜肌减弱术矫正先天性单眼上斜肌麻痹的效果.方法 回顾性分析2015年4月至2016年6月先天性单眼上斜肌麻痹39例的临床资料.患者随机为分两组:上斜肌加强组(19例),实施上斜肌折叠术;下斜肌减弱组(20例),实施下斜肌切断术.术后随访2个月观察治疗效果.结果 两组患者手术前歪头试验均为阳性;手术后原在位、患眼侧的垂直斜视角度均较术前减少,差异有统计学意义(P<0.05).患眼和对侧眼黄斑-视盘夹角差异无统计学意义(P>0.05);且均存在代偿头位.手术后两组患者均出现转阴情况,上斜肌加强组患者转阴率(78.95％)显著高于下斜肌减弱组(25.00％),差异有统计学意义(P<0.05).两组患者患眼与对侧眼黄斑-视盘夹角均较手术前显著减少(P<0.05),总黄斑-视盘夹角较手术前明显下降(P<0.05).两组患者代偿头位均有明显改善(P<0.05).结论 两种手术方式均能够改善患者眼底客观旋转斜度和代偿头位,而上斜肌折叠手术歪头试验转阴率明显高于下斜肌切断术.

abstractsObjective To compare the efficacy of superior oblique muscle strengthening and inferior oblique muscle weakening for the correction of congenital unilateral superior oblique palsy . Methods The data of 39 cases of congenital superior oblique palsy from Apr .2015 to Jun.2016 were analyzed retrospectively .They were divided into two groups randomly .The superior oblique muscle was folded in superior oblique muscle strengthening group of 19 cases and the inferior oblique muscle was cut off in inferior oblique muscle weakening group of 20 cases.Followed up 2months after operation , the efficacy was observed.Rse ults Before operation, the head tilt test of the two groups were all positive .After operation, the original incumbent and the vertical strabismus angle of the affected eye side was decreased in the two groups, and the difference was statistically significant (P<0.05).The difference in the angle of macular and optic disc was not statistically significant between the affected eye and the contralateral eye (P>0.05).The compensatory head posture were present .The patients in both groups turned negative after operation,the negative rate in superior oblique muscle strengthening group was 78.95％ and 25.00％ of inferior oblique weakening group , the difference was statistically significant between the two groups ( P<0.05).The difference in the angle of macular and optic disc between the affected eye and the contralateral eye was significantly decreased compared with that before operation in the two groups (P<0.05), the total angle of macular and optic disc after operation were decreased ( P<0.05), and the compensatory head of the two groups were obviously improved ( P<0.05).Conclusion The two surgical methods of superior oblique muscle strengthening and oblique muscle weakening are able to improve the patients objective rotation inclination and compensatory head position , and the head tilt test negative rate of superior oblique muscle folding is significantly higher than that of inferior oblique myotomy .