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目的 了解主、客观旋转检查结果的临床意义 ,探讨下斜肌减弱术对眼球旋转状态的影响。方法 对 2 0例 (40只眼 )下斜肌功能亢进患者行双眼下斜肌切断或部分切除术 ,应用双马氏杆试验 (DMRT)检查术前、术后 1周及术后 2个月术眼的主观旋转度数 ;术前和术后 1周对其中 15例 (30只眼 )患者行眼底照像 ,并使用绘图软件测量黄斑 视乳头夹角度数 ,记录术眼的客观旋转度数。结果 9例原发性下斜肌功能亢进患者术前DMRT均阴性 ,术后 2个月 1例主观内旋转 5 0°;在 11例下斜肌继发性亢进患者中 ,4例术前DMRT外旋转 2 5°～ 5 0°,术后 2个月 11例均无主观旋转度数。眼底照像示全部患者左、右眼平均客观旋转度数术前分别为外旋转 14 92°± 4 5 1°和外旋转 16 83°± 6 39°,下斜肌减弱手术后 1周分别减少 10 5 4°± 3 75°和 13 0 7°± 3 38° ;双眼手术前、后客观旋转度数比较 ,差异均有非常显著意义 (P <0 0 1)。结论 原发性或出生早期继发性下斜肌功能亢进患者主、客观旋转检查结果不一致。下斜肌减弱术可矫治眼球外旋转斜视 ;术后主观旋转状态的变化存在复杂的代偿机制 ;主、客观旋转状态的变化仍存在不一致性。
Objective To understand the clinical significance of the main and objective rotation test results and to explore the effect of inferior oblique muscle weakening on the rotational state of the eyeball. Methods 20 cases (40 eyes) of lower oblique muscle hypertrophy patients underwent bilateral oblique oblique muscle resection or partial resection, the application of double Markov rod test (DMRT) check preoperative and postoperative 1 week and 2 months after surgery The subjective rotational degree of the eye was measured. The fundus images were taken in 15 cases (30 eyes) before surgery and one week after surgery. The software was used to measure the angle of the macula and the objective rotation degree was recorded. Results Nine patients with primary inferior oblique dysfunction had a negative DMRT before operation, and one subjective rotation was 50 ° at 2 months after operation. Of the 11 patients with secondary oblique obstruction, 4 had preoperative DMRT External rotation of 2 5 ° ~ 5 0 °, 2 months after operation in 11 cases no subjective degree of rotation. Fundus photography showed that the left and right eyes of all patients before the average objective degree of rotation were external rotation 14 92 ° ± 4 5 1 ° and external rotation 16 83 ° ± 39 39 °, lower oblique muscle weakening 1 week after surgery decreased by 10 5 4 ° ± 3 75 ° and 13 0 7 ° ± 3 38 °, respectively. There was significant difference in objective rotation between the two eyes before and after operation (P <0.01). Conclusions The results of primary and objective rotation test in patients with primary or early secondary hypo-oblique muscular dysfunction are inconsistent. Lower oblique muscle surgery can be corrected extra-corporeal rotational strabismus; postoperative subjective rotation state changes complex compensatory mechanism; changes in the main and objective rotation state is still inconsistent.