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目的:观察共同性外斜视合并小度数垂直斜视患者眼外4条直肌Pulley位置、肌肉体积及水平直肌上、下两部分肌肉体积比值的特点。方法:横断面研究。收集2018年1月至2019年12月在天津市眼科医院确诊为共同性外斜视患者，其中第一眼位不合并垂直斜视的患者为A组，第一眼位合并小角度垂直斜视（0.05）。3个组间眼外4条直肌Pulley位置差异均无统计学意义（均n P>0.05）。A组内直肌肌肉体积为（358.6±44.9）mmn 3，B组内直肌肌肉体积为（334.7±35.6）mmn 3，C组内直肌肌肉体积为（437.5±49.3）mmn 3，A组、B组内直肌肌肉体积均小于C组，差异均有统计学意义（n t=6.405，6.025；均n P0.05）。3个组内直肌及外直肌上、下两部分肌肉体积比值差异均无统计学意义（均n P>0.05）；与A组和C组比，B组患者体积比值更分散。n 结论:共同性外斜视合并小度数垂直斜视患者眼外4条直肌Pulley位置变化不明显，内直肌体积明显减小，水平直肌上、下两部分肌肉体积比值分布较分散可能与小度数垂直斜视有关。n （中华眼科杂志，2021，57：223-227）“,”Objective:To observe the changes of four pulley locations of extraocular rectus muscles and rectus muscle volumes, as well as superior and inferior part ratio of horizontal rectus muscles, in concomitant exotropia with small-angle vertical deviation in primary gaze.Methods:Cross-sectional study. Data was collected from January 2018 to December 2019 in Tianjin Eye Hospital. The pulley position changes and volumes of four extraocular rectus muscles in the coronal position of patients who had concomitant exotropia without vertical deviation (group A) or with small-angle vertical deviation in primary gaze (0.05). Among the three groups, the pulley locations of the four extraocular rectus muscles were not significantly different (alln P>0.05). The medial rectus muscle volume in groups A [(358.6±44.9) mmn 3; n t=6.405, n P<0.01] and B [(334.7±35.6) mmn 3; n t=6.025, n P0.05), while the ratio in group B was more dispersive.n Conclusions:The pulley location changes of four extraocular rectus muscles of patients with concomitant exotropia and small-angle vertical deviation in primary gaze are not significant, but the medial rectus volume in patients who had concomitant exotropia with vertical deviation or not is significantly smaller. The dispersive superior and inferior muscle volume ratio of the horizontal rectus muscles may be related to the small angle of vertical deviation in clinical examinations. n (Chin J Ophthalmol, 2021, 57: 223-227)