Lueder Gregg T, Galli Marlo
Department of Ophthalmology and Visual Sciences, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri, USA.
J AAPOS. 2012 Aug;16(4):322-6. doi: 10.1016/j.jaapos.2012.05.005.
Patients with nystagmus may adopt an abnormal head posture if they have a null zone in eccentric gaze. These patients uncommonly present with torticollis due to a null zone when the head is tilted. We describe the results of surgery on the oblique muscles to improve the abnormal head posture in this condition.
This was a retrospective review of patients who had head tilts due to null zones of nystagmus. Surgery consisted of an anterior 50% tenectomy of the superior oblique tendon on one side and recession of the inferior oblique muscle to a position 6 mm posterior to the insertion of the inferior rectus muscle on the contralateral side. The patients' clinical histories and outcomes were reviewed.
Six patients underwent the procedure. Of these, four had infantile nystagmus syndrome and two were born prematurely and had histories of intraventricular hemorrhages. Five of the patients had previous Kestenbaum surgery that corrected the horizontal component of their abnormal head postures. Age at time of surgery for the head tilt ranged from 3 to 13 years. Postoperative follow-up ranged from 1.5 to 3 years. The preoperative head tilts ranged from 25° to 45° (mean, 39°). The postoperative improvement ranged from 20° to 40° (mean, 28°). One of the patients with a history of intraventricular hemorrhage required additional surgery for strabismus unrelated to nystagmus.
Anterior tenectomy of the superior oblique tendon combined with contralateral recession of the inferior oblique muscle improved head tilts related to a null zone of nystagmus.
眼球震颤患者若在偏心注视时有静止眼位区，可能会采取异常头位。这些患者因头部倾斜时的静止眼位区而出现斜颈的情况并不常见。我们描述了在此种情况下对眼外肌进行手术以改善异常头位的结果。
这是一项对因眼球震颤静止眼位区导致头位倾斜患者的回顾性研究。手术包括一侧上斜肌腱前50%切除术以及对侧下斜肌后徙至下直肌附着点后方6mm处。回顾了患者的临床病史和手术结果。
6例患者接受了该手术。其中，4例患有婴儿型眼球震颤综合征，2例为早产儿且有脑室内出血病史。5例患者曾接受过凯斯滕鲍姆手术，该手术纠正了其异常头位的水平成分。头位倾斜手术时的年龄为3至13岁。术后随访时间为1.5至3年。术前头位倾斜角度为25°至45°（平均39°）。术后改善角度为20°至40°（平均28°）。1例有脑室内出血病史的患者因与眼球震颤无关的斜视需要再次手术。
上斜肌腱前切除术联合对侧下斜肌后徙术改善了与眼球震颤静止眼位区相关的头位倾斜。
