Chen L P, Zhang W
Clinical College of Ophthalmology of Tianjin Medical University, Tianjin Eye Hospital, Tianjin Key Lab. of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin 300020, China.
Zhonghua Yan Ke Za Zhi. 2016 Aug;52(8):589-95. doi: 10.3760/cma.j.issn.0412-4081.2016.08.007.
To investigate the effect of superior oblique tucking on the Bielschowsky head tilt test.
A retrospective analysis of 22 patients with congenital unilateral superior oblique palsy, who underwent tucking of the superior oblique tendon in Tianjin Eye Hospital, depending on vertical deviation in the primary position, ocular motility, objective cyclotorsion and abnormal head posture. Bielschowsky head tilt test was evaluated quantitatively by the prism cover test. Α positive Bielschowsky head tilt test was defined as one in which the vertical deviation when the head tilt to the side of the paresis was at least 5. 0(△) greater than that on tilt to the uninvolved side. The follow-up period ranged from 3 to 12 months (mean 4.6 months). Kolmogorov-Smirnov (K-S), Rank sum test and Spearman correlation analysis statistical methods were used in this study.
All patients had vertical deviation and significant abnormal head posture before operation. After the procedure of superior oblique tucking,vertical deviation and symptom of unacceptable abnormal head posture were ameliorated or disappeared. OBJECTIVE torsion was 15.62°±7.36° before the surgery, 9.91°±10.09°1d after the surgery and 11.25°±9.17°at the last follow-up visit, respectively (P<0.05). We found that there were positive correlations between the objective cyclotorsion and the vertical deviation difference value between the paralyzed side and uninvolved side at 1 d after the surgery and last follow-up visit(P<0.05). The vertical deviation of the paresised eye when the head tilted to the side of paresis side and uninvolved side difference were 5.00(△)-17.00(△), average 8.68(△)±3.23(△), 1.00(△)-8.00(△),average 3.36(△)±2.01(△) and 0.00(△)-14.00(△),average 3.77(△)±3.01(△), preoperatively, 1d after the surgery and at the last follow-up visit respectively. Using Rank sum test, the pre-and postoperative difference was statistically significant (Z=-4.64, P<0.01). A positive Bielschowsky head tilt test was found in all cases preoperatively. The results of Bielschowsky tilt test was still positive in 5 cases and negative in 17 cases (77.3%).
In most cases with unilateral superior oblique paresis, the results of Bielschowsky tilt test became negative after superior oblique tucking. The long-standing results is worthy of observation. (Chin J Ophthalmol, 2016, 52: 589-595).
探讨上斜肌折叠术对Bielschowsky歪头试验的影响。
回顾性分析在天津眼科医院接受上斜肌腱折叠术的22例先天性单侧上斜肌麻痹患者，依据原在位垂直斜视度、眼球运动、客观旋转斜视及异常头位情况进行分析。采用三棱镜遮盖试验对Bielschowsky歪头试验进行定量评估。阳性Bielschowsky歪头试验定义为：头向麻痹侧倾斜时的垂直斜视度比向健侧倾斜时至少大5.0（△）。随访时间为3至12个月（平均4.6个月）。本研究采用Kolmogorov-Smirnov（K-S）检验、秩和检验及Spearman相关分析等统计方法。
所有患者术前均有垂直斜视及明显异常头位。上斜肌折叠术后，垂直斜视及难以接受的异常头位症状均有改善或消失。术前、术后1天及末次随访时的客观旋转斜视度分别为15.62°±7.36°、9.91°±10.09°和11.25°±9.17°（P<0.05）。我们发现术后1天及末次随访时客观旋转斜视度与麻痹侧和健侧垂直斜视度差值之间存在正相关（P<0.05）。术前、术后1天及末次随访时，头向麻痹侧倾斜时麻痹眼的垂直斜视度与向健侧倾斜时的差值分别为5.00（△）-17.00（△），平均8.68（△）±3.23（△）；1.00（△）-8.00（△）,平均3.36（△）±2.01（△）；0.00（△）-14.00（△）,平均3.77（△）±3.01（△）。采用秩和检验，术前与术后差异有统计学意义（Z=-4.64，P<0.01）。所有患者术前Bielschowsky歪头试验均为阳性。末次随访时，Bielschowsky歪头试验结果仍为阳性5例（22.7%），阴性17例（77.3%）。
在大多数单侧上斜肌麻痹病例中，上斜肌折叠术后Bielschowsky歪头试验结果变为阴性。长期效果值得观察。（《中华眼科杂志》，2016，52：589-595）
