Stager D R
Ophthalmology Service, Children's Medical Center, and University of Texas Southwestern Health Care Center, Dallas, USA.
J AAPOS. 1997 Dec;1(4):216-25. doi: 10.1016/s1091-8531(97)90041-0.
To establish that the neurovascular bundle (NVB) of the inferior oblique muscle has ligamentous qualities that enable it to function as an ancillary origin to the muscle, particularly after anterior transposition of its insertion.
Fresh cadaveric eyes and eyes of surgical patients were studied. Eighteen orbits were dissected to demonstrate the linear course of the NVB and its adjacent fibrous bands. Intact orbits were analyzed histologically, as were autopsy and surgical specimens, to evaluate the capsule of the NVB and the adjacent fibrous bands. The elastic modulus was measured in NVB specimens and in superior oblique tendons. Six eyes in which recurrent inferior oblique muscle overaction developed after an anterior transposition procedure were surgically explored to determine the structure that was serving as its ancillary origin.
Gross anatomic and microscopic studies showed a linear orientation of the NVB,with adjacent fibrous bands anteriorly joining the inferior oblique and inferior rectus muscle capsules. The NVB showed about 50% fibrocollagenous capsule, with the collagen fibers aligned parallel to the NVB. The elastic modulus was highest (stiffest) in the NVB and lowest in the superior oblique tendon. In patients who had undergone anterior transposition operations, the NVB served as the ancillary origin of the inferior oblique muscle.
The name of the NVB should be changed to neurofibrovascular bundle because it has a prominent fibrocollagenous capsule and is encased in fibrous tissue bands anteriorly. The neurofibrovascular bundle has a linear course and is relatively stiff. It binds the midposterior portion of the inferior oblique muscle posteriorly. Its ligamentous qualities enable it to function as an ancillary origin for the inferior oblique muscle.
证实下斜肌神经血管束（NVB）具有韧带特性，使其能够作为该肌肉的辅助起点发挥作用，尤其是在其附着点前移之后。
对新鲜尸体眼和手术患者的眼睛进行研究。解剖18个眼眶以显示NVB的线性走行及其相邻的纤维带。对完整的眼眶、尸检和手术标本进行组织学分析，以评估NVB的被膜和相邻的纤维带。测量NVB标本和上斜肌腱的弹性模量。对6例在附着点前移手术后出现下斜肌反复亢进的眼睛进行手术探查，以确定作为其辅助起点的结构。
大体解剖和显微镜研究显示NVB呈线性排列，相邻的纤维带在前方连接下斜肌和下直肌的肌囊。NVB约50%为纤维胶原性被膜，胶原纤维与NVB平行排列。弹性模量在NVB中最高（最硬），在上斜肌腱中最低。在接受附着点前移手术的患者中，NVB作为下斜肌的辅助起点。
NVB应更名为神经纤维血管束，因为它有一个突出的纤维胶原性被膜，且前方被纤维组织带包裹。神经纤维血管束走行呈线性且相对较硬。它在后方连接下斜肌的中后部。其韧带特性使其能够作为下斜肌的辅助起点发挥作用。
