Hakim Ossama M, Gaber El-Hag Yasser, Maher Hany
Magraby Eye Center, Madina Munwara, Saudi Arabia.
J AAPOS. 2008 Feb;12(1):62-5. doi: 10.1016/j.jaapos.2007.09.001. Epub 2007 Dec 26.
It is widely assumed that the insertion of the extraocular muscle is the sole site of force translation from muscle to eye. Our aim was to test this assumption by examining ocular motility after disinsertion of the extraocular muscle.
Forty-two adults (age, 20-45 years; median age, 26 years) underwent strabismus surgery. All surgeries were completed under topical anesthesia with lidocaine 2% jelly or peribulbar sensorimotor differential blocking anesthesia with ropivacaine 0.2%. Sixty-six rectus muscles and six oblique muscles were suture-locked and disinserted. After disinsertion of each muscle, the patient was asked to move the eye in the field of action of the muscle; eye movement was recorded as normal, reduced, or absent.
For 50 rectus muscles (76%), eye movement was normal after disinsertion, while for 14 rectus muscles (21%), eye movement was reduced after disinsertion. For only two rectus muscles (3%), eye movement was absent after disinsertion. For all six oblique muscles (100%), eye movement was normal after disinsertion.
The unexpected, strong persistence of eye movement in the direction of action of the disinserted muscle indicates that anatomic insertion not only occurs at the point at which the muscle blends into the sclera but also involves the surrounding connective tissue. Orbital connective tissue can be considered an additional and important locomotor system.
人们普遍认为眼外肌的附着点是肌肉向眼球传递力量的唯一部位。我们的目的是通过检查眼外肌离断后的眼球运动来验证这一假设。
42名成年人（年龄20 - 45岁；中位年龄26岁）接受斜视手术。所有手术均在局部麻醉下完成，使用2%利多卡因凝胶或0.2%罗哌卡因球周感觉运动差速阻滞麻醉。66条直肌和6条斜肌被缝线固定并离断。每条肌肉离断后，要求患者在该肌肉的作用范围内移动眼球；眼球运动记录为正常、减弱或消失。
50条直肌（76%）离断后眼球运动正常，14条直肌（21%）离断后眼球运动减弱。只有2条直肌（3%）离断后眼球运动消失。所有6条斜肌（100%）离断后眼球运动正常。
离断肌肉作用方向上意外且强烈持续的眼球运动表明，解剖学上的附着不仅发生在肌肉与巩膜融合的点，还涉及周围的结缔组织。眼眶结缔组织可被视为一个额外且重要的运动系统。
