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目的 :探讨先天性上斜肌麻痹术后正位的代偿头位、Bielschowsky征及双眼视觉的恢复规律。方法 :对 36例先天性上斜肌麻痹经手术治疗后 ,眼位达正位者 (原在位垂直斜视度≤ 5 △)的临床资料进行分析。结果 :①术前 36例中 ,伴代偿头位 2 6例 ,术后代偿头位消失 14例 (5 3 8% ) ,好转 12例 (4 6 2 % ) ,头位消失时间为术后 1天至术后 3个月 ,平均 33 8天。②术后Bielschowsky征阴性 2 5例 (6 9 4 % ) ,阳性 11例 (30 6 % )。③术前存在同时知觉、融合功能、远立体视、近立体视者分别为 7例 (19 4 % ) ,6例 (16 7% ) ,3例 (8 3% ) ,1例 (2 8% ) ;术后存在同时知觉、融合功能、远立体视、近立体视者分别为 31例(86 1% ) ,2 9例 (80 6 % ) ,2 2例 (6 1 1% ) ,10例 (2 7 8% )。结论 :①先天性上斜肌麻痹伴代偿头位者仅部分有双眼视功能。②评判术后代偿头位消失与否 ,至少应观察 1个月以上。③Bielschowsky征阴性不应作为评判上斜肌麻痹治愈的绝对标准。
Objective: To investigate the recovery of anterior oblique position, Bielschowsky sign and binocular vision after congenital superior oblique palsy. Methods: Thirty - six cases of congenital superior oblique paralysis were analyzed retrospectively. The clinical data of orthophoria (original orthophoria ≤ 5 △) were analyzed. Results: (1) 36 preoperative patients had 26 cases with compensatory head, 14 cases (538%) disappeared after operative decompensation, 12 cases (462%) improved, the disappearance time of head position was After 1 day to 3 months after surgery, with an average of 33 8 days. ②Postoperative Bielschowsky sign negative 25 cases (69.4%), positive in 11 cases (30.6%). There were 7 cases (19.4%), 6 cases (16.7%), 3 cases (83%) and 1 case (28%) with preoperative simultaneous perception, fusion function, far stereopsis, ). There were 31 cases (86.1%), 29 cases (80.6%), 22 cases (21.1%) and 10 cases (2 7 8%). Conclusions: ① Congenital superior oblique paralysis with compensatory head only partial binocular vision. ② judge the disappearance of postoperative compensatory head or not, at least one month or more should be observed. ③ Bielschowsky sign negative should not be used as a judge of upper oblique muscle paralysis absolute standard of cure.