目的:探讨先天性双上转肌麻痹的眼外肌影像学特点和个性化的手术处理方法。方法:回顾性病例研究。收集2006-04/2009-07先天性双上转肌麻痹患者16例行眼眶CT检查,根据CT表现及临床检查设计不同手术治疗,观察手术前后眼位、斜视度数及临床特征的变化。结果:眼外肌CT出现明显变化者81.3%(13/16),表现为受累眼上直肌群最大截面积减小者68.7%(11/16),表现为受累眼下直肌最大截面积增大者12.5%(2/16);在11例受累侧上直肌群最大截面积减小组中,受累侧上直肌群最大截面积为9.95±2.82mm2,明显小于对侧(24.52±5·42mm2,P<0.01),而受累侧(21.20±3.82mm2)与对侧(23.41±4.73mm2)下直肌最大截面积无明显差异;行个性化手术治疗15例,治愈14例,好转1例,8例上睑下垂患者症状消失,7例改善。结论:上直肌群发育不良是先天性双上转肌麻痹的主要机制之一;先天性双上转肌麻痹是一种个体差异明显的特殊类型斜视,需要根据其临床检查及影像学特点设计个性化的手术方案;眼外肌CT可以为临床选择适合的手术治疗方法提供有价值的信息。

AIM: To investigate the characteristics of the imaging of extraocular muscles in congenital double elevator paralysis(CDEP) and to evaluate different surgical outcomes based on imaging and clinical findings. METHODS: Sixteen patients were included in this retrospective study, from April 2006 to July 2009. Pre-operation ophthalmologic examination and orbit CT scan were performed. The choice of surgical procedure was based on the result of clinical evaluation and CT imaging. RESULTS: It showed that 81.3%(13/16) patients showed significant changes in extraocular muscles. In 68.7%(11/16) patients coronal images, the maximum cross-sectional area of superior rectus complex in affected eye became thinner than that of contralateral eye (9.95±2.82mm2 vs 24.52±5.42mm2,P<0.01),while no significant difference was found in inferior rectus(21.20±3.82mm2 vs 23.41±4.73mm2, P>0.05). In two patients, the maximum cross-sectional area of inferior rectus in affected eye became thicker than that of contralateral eye. The vertical misalignment was completely corrected in 14 patients and partially corrected in 1 patient. Psuedoptosis totally disappeared in 8 patients and partially improved in 7 patients. CONCLUSION: Either congenital hypoplasia or paresis of superior rectus muscle in affected eye may be one of the main reasons of CDEP. Surgical procedures for CDEP must be individualized according to clinical evaluation and imaging. Extraocular muscle CT imaging may give clinically valuable information for appropriate surgical planning.

R779.6