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上斜肌为眼球旋转垂直运动眼外肌麻痹中最常见的受累肌。有时是单眼,但两眼上斜肌同时受累者亦较常见。先天性上斜肌麻痹的患者常表现为垂直性斜视和代偿性头位。因此上斜肌麻痹的手术治疗目标,主要在于矫正斜视,使之能获得最大限度的融合功能,消除代偿性头位。先天性上斜肌麻痹的手术方式主要有两类:一是加强麻痹肌即上斜肌折叠术,二是下斜肌减弱术。从1908年Posey首先采用下斜肌减弱术至今已有近百年的历史,人们不但对下斜肌的解剖及其病理生理有了很深的了解,而且采用了先进的影像技术〔1〕和计算机模拟演示的方法〔2〕,从动态上对下斜肌有了更深的认识。下斜肌减弱术有下斜肌断腱术、下斜肌切除术、下斜肌边缘切开术,下斜肌后徙术及下斜肌前转位术。所以对各类下斜肌手术评价是很有必要的,为临床实践提供参考。
The upper oblique muscle is the most common affected muscle in the paralysis of the extraocular muscle due to vertical rotation of the eyeball. Occasionally, it is monocular, but it is also common for upper oblique muscles to be affected at the same time. Patients with congenital upper oblique paralysis often show vertical strabismus and compensatory head position. Therefore, the surgical treatment of supraspinatus paralysis, the main goal is to correct strabismus, so that it can maximize the fusion function, the elimination of compensatory head position. Congenital upper oblique muscle paralysis surgery there are two main ways: First, to strengthen the paralyzed muscle that oblique muscle fold surgery, and second, lower oblique muscle surgery. Posey from the first use of inferior oblique muscle weakened in 1908 has been nearly a hundred years of history, people not only on the anatomy of lower oblique and its pathophysiology have a deep understanding, and the use of advanced imaging technology [1] and the computer Simulation of the method [2], from the dynamic on the lower oblique have a deeper understanding. Lower oblique muscle surgery have inferior oblique muscle tendon surgery, inferior oblique resection, incision under the edge of the lower oblique, posterior oblique surgery and posterior oblique transfer surgery. Therefore, various types of inferior oblique muscle surgery evaluation is necessary, to provide a reference for clinical practice.