Molinari Andrea, Ugrin Maria Cristina
Hospital Metropolitano, Centro Medico Meditropoli, Av. Mariana de Jesus y Nicolas Arteta, Quito, Ecuador.
J AAPOS. 2009 Dec;13(6):571-4. doi: 10.1016/j.jaapos.2009.08.015.
Superior oblique palsy is accompanied in most cases by overaction of the muscle's ipsilateral antagonist, the inferior oblique muscle. Overaction and contracture of the ipsilateral superior rectus muscle in patients with unilateral fourth (trochlear) nerve palsy is seldom discussed in the literature. The purpose of this study is to evaluate the frequency of superior rectus muscle overaction/contracture syndrome in patients with unilateral trochlear nerve palsy.
The records of 198 patients with unilateral trochlear nerve palsy examined by the authors between July 1987 and July 2008 were reviewed retrospectively. All patients underwent complete eye examination with measurement of the deviation in the 9 positions of gaze and with the head tilted to both sides in all cooperative patients. Selection criteria for superior rectus muscle overaction/contracture syndrome in these patients were as follows: vertical deviation of 15(Delta) or larger in primary position, equal or larger hypertropia with the ipsilateral forced tilt test than with the eyes looking straight ahead, more than 5(Delta) hypertropia of the affected eye in horizontal gaze to the same side, hypertropia in all upgazes, and overaction of the contralateral superior oblique muscle.
Of 198 patients, 33 (16.6%) met the selection criteria for superior rectus muscle overaction/contracture syndrome.
Superior rectus muscle overaction/contracture syndrome frequently occurs in unilateral superior oblique palsy.
在大多数情况下，上斜肌麻痹伴有该肌同侧拮抗肌即下斜肌的亢进。单侧滑车神经麻痹患者同侧上直肌的亢进和挛缩在文献中很少被讨论。本研究的目的是评估单侧滑车神经麻痹患者上直肌亢进/挛缩综合征的发生率。
回顾性分析了作者在1987年7月至2008年7月期间检查的198例单侧滑车神经麻痹患者的病历。所有患者均接受了全面的眼部检查，测量了在9个注视位置的斜视度以及在所有合作患者中向两侧倾斜头部时的斜视度。这些患者上直肌亢进/挛缩综合征的选择标准如下：原在位垂直斜视度为15棱镜度或更大，同侧强迫性头位试验时的上斜视度等于或大于正视时，向同侧水平注视时患眼上斜视度超过5棱镜度，所有上注视时均有上斜视，以及对侧上斜肌亢进。
198例患者中，33例（16.6%）符合上直肌亢进/挛缩综合征的选择标准。
上直肌亢进/挛缩综合征在单侧上斜肌麻痹中经常发生。
