- 期刊
- OpenAccess
隱蔽型雙側性上斜肌麻痹之發生率及臨床特徵
Incidence and Clinical Features of Masked Bilateral Superior Oblique Palsy
摘要
單側性上斜肌麻痹及雙側性上斜肌麻痹在預後及治療方面均有所不同，因此如何在二者間作一鑑別診斷是非常重要的。我們收集了54位在台中榮總診斷為上斜肌麻痹的病人，來評估隱蔽型雙側性上斜肌麻痹的發生率及臨床特徵。隱蔽型雙側性上斜肌麻痺的發性率是22.4%(11/49)。上斜肌麻痹手術治療後，對側的上斜肌麻痹被“顯露”出來的時間，範圍從10天到16個月不等，平均是4.9個月。外傷造成上斜肌麻痹的百分比，在單側性、隱蔽型雙側性及雙側性上斜肌麻痹這三組中，分別為13%、9%和40%。上斜肌麻痹相關的症狀依序為傾斜頭位、外斜視、複視、內斜視、眼球震顱和弱視。另外，當頭部傾斜至麻痹側及非麻痹側，所測得上斜視的角度，在單側性及隱蔽型雙側性上斜肌麻痹這二組病人分別為19.3、6.1及19.1、4.0PD。讓病患視線分別固定於一近物及一遠物，用alternate prism cover test所測上斜視的角度，在單側性及隱蔽型雙側性上斜肌麻痺這二組病人分別為14.0、15.6PD及9.0、9.3PD，但並無統計學上的差異。單側性及隱蔽型雙側性上斜肌麻痹的臨床特徵是非常的類似，以至於手術前無法在二者間作一正確之鎰別診斷。因此，永遠認定上斜肌麻痹是雙側性的，直到證明不是為止。
關鍵字
無資料並列摘要
Unilateral and bilateral superior oblique palsy (SOP) differ in prognosis and treatment, so it is very important to differentiate between these two types of SOP. Fifty-four consecutive patients with SOP seen at Taichung Veterans General Hospital were reviewed to evaluate the incidence and clinical features of masked bilateral SOP (MBSOP). Incidence of MBSOP is 22.4% (11/49). The time interval of ”unmasking” of the contralateral SOP after the first surgery ranged from 10 days to 16 months (mean 4.9 months). Percentage of traumatic SOP is 13%, 9% and 40% in unilateral SOP (USOP), MBSOP and bilateral SOP (BSOP) respectively. Symptoms and signs associated with SOP are head tilt posture, XT, diplopia, ET, nystagmus and amblyopia. Prism diopters of hypertropia when head tilted to the paretic/nonparetic side were 19.3/6.1 and 19.1/4.0 in USOP and MBSOP. The results of APCT when patients fixed at a near/distant object showed 14.0/15.6 and 9.0/9.3 prism diopters of hypertropia in USOP and MBSOP but no statistical differences were noted. Clinical features of unilateral and masked bilateral SOP are so similar that differential diagnosis cannot be made before operation. So, always assume SOP is bilateral until proven otherwise.