| 目的 探讨双上转肌麻痹和双下转肌麻痹的临床特征和手术方式及疗效。方法 根据患者不同情况进行个体化手术治疗，并观察手术前后视力、眼位、眼外肌功能及代偿头位变化。结果 23例双上转肌麻痹和双下转肌麻痹患者均有明显的垂直运动障碍并部分伴低位眼上睑下垂及代偿头位，术前垂直斜度平均为38.3∆+/-16.7∆，经手术治疗术后患者垂直斜视度平均为9.2∆+/-9.2∆，较术前改善29.1∆+/-15.0∆；其中17例（73.9%）患者垂直斜度10∆。治愈12例占52.2%；好转10例占47.5%；仅1例双下转肌麻痹患者经两次手术后上斜矫正40∆但仍残留40∆垂直斜度。结论 双上转肌麻痹和双下转肌麻痹是临床上少见的两种眼垂直运动障碍性疾病，他们的诊断和治疗较为复杂，但通过仔细的眼外肌功能检查和个体化的手术治疗可获得良好的疗效，不但眼位偏斜明显矫正，假性上睑下垂和代偿头位获得明显改善，也为提高斜视性弱视眼视力和双眼立体视觉提供了有利基础。
Objective: To investigate the Clinical feature of double elevator palsy and double depressor palsy and their surgical method and therapeutic effect. Methods: All patients were treated by individual operation. Pre- and post-operative eye position, movement, pseudoptosis and compensatory head posture ,Clinical features were examined and analyzed in 23 patients with double elevator palsy and double depressor palsy. Result: The clinic characteristics of patient were the marked limitation of vertical movement in the eye with double elevator palsy or double depressor palsy. The mean preoperative vertical deviation was 38.3∆+/-16.7∆ and the mean postoperative vertical deviation was 9.2∆+/-9.2∆,The mean corrected deviation for all cases was 21.7 PD +/-4. 9 PD and 17 of 23 patients（73.9%）postoperative vertical deviation10∆,the overall surgical "success" rate was 52.2%. Conclusion: The diagnosis was based on the marked limitation of vertical movement , pseudoptosis and compensatory head posture. The treatment individual operation is an effective and satisfied way for double elevator palsy and double depressor palsy. |
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