Helveston E M, Krach D, Plager D A, Ellis F D
Department of Ophthalmology, Indiana University School of Medicine, Indianapolis.
Ophthalmology. 1992 Oct;99(10):1609-15. doi: 10.1016/s0161-6420(92)31759-2.
Superior oblique palsy is the most frequent isolated cranial nerve palsy seen in strabismus practice. It is traditionally diagnosed according to etiology as acquired, congenital, or idiopathic, but surgical treatment is based on deviation not etiology. Observations at surgery led to speculation that the superior oblique tendon is different in congenital compared with acquired superior oblique palsy and that this difference should be considered in surgical treatment.
The authors reviewed the charts of 82 patients (89 eyes) undergoing surgery on the superior oblique tendon for superior oblique palsy. In each case, the palsy had been diagnosed preoperatively as acquired, congenital, or idiopathic, and, at surgery, characteristics of the tendon anatomy were described.
Thirty-eight superior oblique tendons (36 patients), diagnosed as congenital superior oblique palsy, included 33 abnormal tendons and 5 normal tendons. Twenty-four tendons (21 patients), diagnosed as traumatic superior oblique palsy, included 22 normal and 2 abnormal tendons. Twenty-seven tendons (25 patients), diagnosed as idiopathic, included 19 normal and 8 abnormal tendons. Abnormal tendons were divided into 4 categories: (1) redundant, (2) misdirected, (3) inserted in posterior Tenon's capsule, and (4) absent.
The authors conclude that congenital superior oblique palsy is usually associated with a structural abnormality of the superior oblique tendon (87%). Whereas acquired superior oblique palsy usually has a normal tendon (92%). Superior oblique underaction in acquired superior oblique palsy results from a neural deficit. Potential variance in anatomy of the superior oblique tendon should be considered when undertaking surgery for superior oblique palsy.
上斜肌麻痹是斜视临床中最常见的孤立性脑神经麻痹。传统上根据病因将其诊断为后天性、先天性或特发性，但手术治疗是基于斜视度而非病因。手术中的观察结果引发了这样的推测，即先天性上斜肌麻痹与后天性上斜肌麻痹相比，上斜肌腱存在差异，并且在手术治疗中应考虑这种差异。
作者回顾了82例（89只眼）因上斜肌麻痹接受上斜肌腱手术患者的病历。在每例病例中，术前已将麻痹诊断为后天性、先天性或特发性，并且在手术中描述了肌腱解剖结构的特征。
38条上斜肌腱（36例患者）被诊断为先天性上斜肌麻痹，其中包括33条异常肌腱和5条正常肌腱。24条肌腱（21例患者）被诊断为外伤性上斜肌麻痹，其中包括22条正常肌腱和2条异常肌腱。27条肌腱（25例患者）被诊断为特发性，其中包括19条正常肌腱和8条异常肌腱。异常肌腱分为4类：（1）冗长；（2）走行异常；（3）附着于后Tenon囊；（4）缺如。
作者得出结论，先天性上斜肌麻痹通常与上斜肌腱的结构异常相关（87%）。而后天性上斜肌麻痹的肌腱通常正常（92%）。后天性上斜肌麻痹中，上斜肌功能不足是由神经缺陷导致的。在进行上斜肌麻痹手术时，应考虑上斜肌腱解剖结构的潜在差异。
