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中华眼科医学杂志(电子版) ›› 2017, Vol. 07 ›› Issue (03) : 140 -144. doi: 10.3877/cma.j.issn.2095-2007.2017.03.008

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综述

动眼神经麻痹的定位诊断及治疗进展
张阳1, 李俊红2,()   
  1. 1. 030001 山西医科大学
    2. 030001 山西医科大学;030002 山西省眼科医院斜视与小儿眼科
  • 收稿日期:2017-05-22 出版日期:2017-06-28
  • 通信作者: 李俊红

Localization diagnosises and the treatments progress of third nerve palsy

Yang Zhang1, Junhong Li2,()   

  1. 1. Shanxi Medical University, Taiyuan 030001, China
    2. Shanxi Medical University, Taiyuan 030001, China; Strabismus and pediatric ophthalmology, Shanxi Eye Hospital, Taiyuan 030002, China
  • Received:2017-05-22 Published:2017-06-28
  • Corresponding author: Junhong Li
  • About author:
    Corresponding author: Li Junhong, Email:
引用本文:

张阳, 李俊红. 动眼神经麻痹的定位诊断及治疗进展[J/OL]. 中华眼科医学杂志(电子版), 2017, 07(03): 140-144.

Yang Zhang, Junhong Li. Localization diagnosises and the treatments progress of third nerve palsy[J/OL]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2017, 07(03): 140-144.

动眼神经麻痹是一种可由多种病因导致的眼球运动异常、上睑下垂及瞳孔受损的疾病,是非共同性斜视的重要病因之一。动眼神经麻痹的临床表现为上睑下垂、眼球上转、内转、下转受限、患眼瞳孔散大及对光反应迟钝或消失。常见病因有脑血管疾病、头部外伤、肿瘤、炎症及内分泌代谢疾病等。本文着重从动眼神经的解剖路径、定位诊断、常见病因及治疗等方面,对动眼神经麻痹的临床特征及处理原则进行概述。

Third nerve palsy is a disease of abnormal eye movements, ptosis and pupillary damage caused by a variety of causes, and it is one of the most important causes of non concomitant strabismus. The clinical manifestations of Third paralysis ptosis, eye rotation, in turn, have limited pupil Kong Sanda and unresponsive to light or disappear. Common causes include cerebrovascular disease, head trauma, tumor, inflammation and endocrine and metabolic diseases. In this paper, the clinical features and treatment principles of Third nerve paralysis are reviewed from the aspects of anatomy, location, diagnosis, common cause and treatment of Third nerve.

图1 外直肌劈开转位至鼻侧图解[68] A图示前面观,B图示上面观,C图示下面观;N与P示可调节滑动套索,MR示内直肌,LR示外直肌,SR示上直肌,IR示下直肌,SO示上斜肌,IO示下斜肌
[1]
Green WR, Hackett ER, Schlezinger NS. Neuro-ophthalmologic evaluation of, oculomotor nerve paralysis[J]. Archives of Ophthalmology, 1964, 72(2):154-167.
[2]
Berlit P. Isolated and combined pareses of cranial nerves III, IV and VI. A retrospective study of 412 patients[J]. Journal of the Neurological Sciences, 1991, 103(1):10-15.
[3]
Rucker CW. Paralysis of the third, fourth and sixth cranial nerves[J]. Am J Ophthalmol, 1958, 46(6):787-794.
[4]
Rucker CW. The causes of paralysis of the third, fourth and sixth Cranial Nerves[J]. Am J Ophthalmol, 1966, 61(5):1293-1298.
[5]
Rush JA, Younge BR. Paralysis of cranial nerves III, IV, and VI. Cause and prognosis in 1,000 cases[J]. Arch Ophthalmol, 1981, 99(1):76-79.
[6]
冷守忠,吕小琪,庞式琪. 动眼神经麻痹246例的病因分析[J]. 中华眼科杂志,1994,30(1):31-33.
[7]
徐肖. 单纯动眼神经麻痹病因分析[J]. 临床眼科杂志,2005,13(2):169-170.
[8]
Ng YS, Lyons CJ. Oculomotor nerve palsy in childhood[J]. Can J Ophthalmol, 2005, 40(5):645-653.
[9]
Victor DI. The diagnosis of congenital unilateral third-nerve palsy[J]. Brain, 1976, 99(4):711-718.
[10]
Balkan R, Hoyt CS. Associated neurologic abnormalities in congenital third nerve palsies[J]. Am J Ophthalmol, 1984, 97(3):315-319.
[11]
Miller NR. Solitary oculomotor nerve palsy in childhood[J]. Am J Ophthalmol, 1977, 83(1):106-111.
[12]
Ing EB, Sullivan TJ, Clarke MP, et al. Oculomotor nerve palsies in children[J]. J Pediatr Ophthalmol Strabismus, 1992, 29(6):331-336.
[13]
Heinze J. Cranial nerve avulsion and other neural injuries in road accidents[J]. Med J Aust, 1969, 2(25):1246-1249.
[14]
李文伟. 缺血性-糖尿病性动眼神经麻痹[J]. 中华神经科杂志,2001,34(6):335.
[15]
李真,刘淑琴. 糖尿病性动眼神经麻痹临床分析[J]. 中国斜视与小儿眼科杂志,2010,18(1):13-15.
[16]
蒲一民,徐智科,刘宗顺,等. 首诊动眼神经麻痹35例病因分析[J]. 国际眼科杂志,2013,13(8):1694-1696.
[17]
张承芬,张惠蓉. 糖尿病的眼部并发症及治疗[M]. 北京:人民卫生出版社,2003:170-173.
[18]
刘家琦,李凤鸣. 实用眼科学[M]. 北京:人民卫生出版社,2010:614-615.
[19]
Choi YJ, Lee SH, Park MS, et al. Midbrain infarction presenting with monocular elevation palsy and ptosis: topographic lesion analysis[J]. J Neuroophthalmol, 2015, 35(2):175-178.
[20]
Prasad S. Paralytic Strabismus: Third, Fourth, and Sixth Nerve Palsy[J]. Neuro Clin, 2010, 28(3):803-833.
[21]
Adams ME, Linn J, Yousry I. Pathology of the ocular motor nerves III, IV, and VI[J]. Neuroimaging Clin N Am, 2008, 18(2):261-282.
[22]
纪荣明,周晓平,岳志健,等. 动眼神经的应用解剖学[J]. 解剖学杂志,2001,24(4):385-387.
[23]
Takahashi M, Kase M, Suzuki Y, et al. Incomplete Oculomotor Palsy with Pupil Sparing Caused by Compression of the Oculomotor Nerve by a Posterior Communicating Posterior Cerebral Aneurysm[J]. Jpn J Ophthalmol, 2007, 51(6):470.
[24]
Atasever A, Durgun B, Celik HH, et al. Somatotopic organization of the axons innervating the superior rectus muscle in the oculomotor nerve of the rat[J]. Acta Anatomica, 1993, 146(4):251-254.
[25]
Bennett JL, Pelak VS. Palsies of the third, fourth, and sixth cranial nerves[J]. Ophthalmol Clin North Am, 2001, 14(1):169-185.
[26]
Brazis PW, Masdeu JC, Biller J. Localization in Clinical Neurology[M]. Philadelphia: Lippincott Williams & Wilkins, 2011: 173-303.
[27]
Kung NH, Van Stavern GP. Isolated Ocular Motor Nerve Palsies[J]. Seminars in Neurology, 2015, 35(5):539-548.
[28]
Aoki K, Sakaue T, Kubota N, et al. Outcome of surgery for bilateral third nerve disorder[J]. Jpn J Ophthalmol, 2002, 46(5):540.
[29]
Rush JA, Younge BR, Campbell RJ, et al. Optic glioma. Long-term follow-up of 85 histopathologically verified cases[J]. Ophthalmology, 1982, 89(11):1213-1219.
[30]
Good WV, Hyot CS. Strabismus management[M]. Boston: Butterworth-Heinemann, 1996: 287-295.
[31]
Golikhatir I, Aminiahidashti H, Motamed MH, et al. Isolated Oculomotor Nerve Palsy Following Minor Head Trauma; a Case report[J]. Emergency, 2017, 5(1):e42.
[32]
刘卫华,周红利. 滑车神经行经小脑幕侧方区域的应用解剖学研究[J]. 华西医学,2009,24(3):683-685.
[33]
Gladstone JP. An approach to the patient with painful ophthalmoplegia, with a focus on Tolosa-Hunt syndrome[J]. Current Pain and Headache Reports, 2007, 11(4):317-325.
[34]
Gladstone JP, Dodick DW. Painful ophthalmoplegia: Overview with a focus on tolosa-hunt syndrome[J]. Current Pain and Headache Reports, 2004, 8(4):321-329.
[35]
Walsh FB, Hyot WF. Clinical Neuro-Ophthalmology[M]. 3rd ed, Baltimore: Williams & Wilkins Co, 1969: 255-256.
[36]
郝照莲. 复方樟柳碱治疗缺血性视神经病变[J]. 眼科新进展,2004,24(5):368.
[37]
张蔚,李波,杨鹤超,等. 复方樟柳碱治疗外伤性动眼神经麻痹20例[J]. 眼科新进展,2006,26(3):223.
[38]
张薇. 中西医结合治疗动眼神经麻痹84例临床研究[J]. 中国中医基础医学杂志,2014(3):402-403.
[39]
李春林. 中西医结合治疗动眼神经麻痹疗效观察[J]. 中国实用神经疾病杂志,2015,18(10):25-27.
[40]
林明,李瑾,范先群,等. 上睑下垂术后发生暴露性角膜炎的相关因素研究[J]. 中国实用眼科杂志,2007,25(11):1202-1204.
[41]
周凤,刘桂琴,刘春明,等. 动眼神经麻痹手术治疗临床疗效观察[J]. 国际眼科杂志,2010,10(2):344-346.
[42]
Good WV, Hoyt CS. Behavioral correlates of poor vision in children[J]. International Ophthalmology Clinics, 1989, 29(1):57-60.
[43]
Helveston EM. Muscle transposition procedures[J]. Surv Ophthalmol, 1971, 16(2):92.
[44]
Kattleman B, Flanders M, Wise J. Supramaximal horizontal rectus surgery in the management of third and sixth nerve palsy[J]. Can J Ophthalmol, 1986, 21(6):227-230.
[45]
Knapp P. Vertically Incomitant Horizontal Strabismus: The So-called " A" and " V" Syndromes[J]. Trans Am Ophthalmol Soc, 1959, 57(2):666-699.
[46]
Köse S, Uretmen O, Pamukçu K. An approach to the surgical management of total oculomotor nerve palsy[J]. Strabismus, 2001, 9(1):1-8.
[47]
Villaseñor SJ, Riemann BI, Romanelli ZAC, et al. Ocular fixation to nasal periosteum with a superior oblique tendon in patients with third nerve palsy[J]. Journal of Pediatric Ophthalmology & Strabismus, 2000, 37(5):260-265.
[48]
Peter LC. The Use of the Superior Oblique as an Internal Rotator in Third Nerve Paralysis[J]. Trans Am Ophthalmol Soc, 1933, 17(4):232-237.
[49]
Wiener M, Scheie HG. Surgery of the Eye[M]. 3rd ed, New York: Grune and Stratton, 1952: 405.
[50]
Reinecke RD. Surgical results of third cranial nerve palsies[J]. New York State Journal of Medicine, 1972, 72(11):1255-1257.
[51]
Scott AB. Transposition of the superior oblique[J]. Am Orthopt J, 1977, 27(1):11-14.
[52]
Harley RD. Paralytic strabismus in children. Etiologic incidence and management of the third, fourth, and sixth nerve palsies[J]. Ophthalmology, 1980, 87(1):24.
[53]
Maruo T, Iwashige H, Kubota N, et al. Results of Surgery for Paralytic Exotropia due to Oculomotor Palsy[J]. Ophthalmologica, 1996, 210(3):163-167.
[54]
Singh A, Pandey PK, Mittal SK, et al. Impact of Superior Oblique Transposition on Primary Position Deviation, a Pattern and Intorsion in Third Nerve Palsy[J]. Strabismus, 2016, 24(4):173-177.
[55]
Singh A, Bahuguna C, Nagpal R, et al. Surgical management of third nerve palsy[J]. Oman Journal of Ophthalmology, 2016, 9(2):80-86.
[56]
Mora J. An adjustable medial orbital wall suture for third nerve palsy[J]. Clin Experiment Ophthalmol, 2004, 32(5):460-461.
[57]
Saxena R, Sinha AP, Phuljhele S, et al. Precaruncular approach for medial orbital wall periosteal anchoring of the globe in oculomotor nerve palsy[J]. J AAPOS, 2009, 13(6):578-582.
[58]
Ahmed R, Coats DK, Yen MT. Periosteal Flap fixation of the Globe for Surgical Treatment of Severe Restrictive Strabismus: A Report of Eight Cases with Outcomes[J]. Binocul Vis Strabolog Q Simms Romano, 2011, 26(4):230-235.
[59]
Hull S, Verity DH, Adams GG. Periosteal muscle anchoring for large angle incomitant squint[J]. Orbit, 2012, 31(31):1-6.
[60]
O′Day J. Surgical management of oculomotor nerve palsy[J]. Aust N Z J Ophthalmol, 1991, 111(5):71-76.
[61]
Young TL, Conahan BM, Summers CG, et al. Anterior transposition of the superior oblique tendon in the treatment of oculomotor nerve palsy and its influence on postoperative hypertropia.[J]. J Pediatr Ophthalmol Strabismus, 2000, 37(3):149-155.
[62]
Taylor JN. Surgical management of oculomotor nerve palsy with lateral rectus transplantation to the medial side of globe[J]. Aust N Z J Ophthalmol, 1989, 17(1):27-31.
[63]
Sukhija J, Kaur S, Singh U. Nasal lateral rectus transposition combined with medial rectus surgery for complete oculomotor nerve palsy[J]. J AAPOS, 2014, 18(4):395-396.
[64]
Saxena R, Phuljhele S, Sharma P, et al. Periosteal Fixation Procedures in the Management of Incomitant Strabismus[J]. Middle East African Journal of Ophthalmology, 2015, 22(3):320-326.
[65]
Morad Y, Nemet P. Medial transposition of the lateral rectus muscle in combined third and fourth nerve palsy[J]. J AAPOS, 2000, 4(4):246-247.
[66]
Kaufmann H. Lateralis splitting in total oculomotor paralysis with trochlear nerve paralysis (Article in German)[J]. Fortschr Ophthalmol, 1991, 88(3):314-316.
[67]
Gokyigit B, Akar S, Satana B, et al. Medial transposition of a split lateral rectus muscle for complete oculomotor nerve palsy[J]. J AAPOS, 2013, 17(4):402-410.
[68]
Shah AS, Prabhu SP, Sadiq MA, et al. Adjustable nasal transposition of split lateral rectus muscle for third nerve palsy[J]. JAMA Ophthalmology, 2014, 132(8):963-969.
[69]
Lee AG, Brazis PW. The emerging role of magnetic resonance angiography in the management of patients with third nerve palsy[J]. Am J Ophthalmol, 2000, 129(1):115-116.
[70]
Wong GK, Ng SC, Tsang PK, et al. Clipping vs coiling of posterior communicating artery aneurysms with third nerve palsy[J]. Digest of the World Core Medical Journals, 2006, 66(1):121-123.
[71]
Andrewg L, Lanne H, Paulw B. The evaluation of isolated third nerve palsy revisited: an update on the evolving role of magnetic resonance, computed tomography, and catheter angiography[J]. Survey of Ophthalmology, 2002, 47(2):137-157.
[72]
Kupersmith MJ, Heller G, Cox TA. Magnetic resonance angiography and clinical evaluation of third nerve palsies and posterior communicating artery aneurysms[J]. Journal of Neurosurgery, 2006, 105(2):228-234.
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