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中华眼科医学杂志(电子版)

中华眼科医学杂志(电子版) ›› 2023, Vol. 13 ›› Issue (05) : 285 -290. doi: 10.3877/cma.j.issn.2095-2007.2023.05.006

综述

单眼上转不足的研究进展
王依平, 李俊红†(), 冯张青   
  1. 030001　太原，山西医科大学第一临床医学院2021级硕士研究生
    030002　太原，山西省眼科医院斜视与小儿眼科　山西医科大学附属眼科医院
  • 收稿日期:2023-06-10 出版日期:2023-10-28
  • 通信作者: 李俊红
  • 基金资助:
    山西省卫生健康委科研课题(2020040); 山西省眼科医院院内创新基金项目(C202202)

Research progress of monocular elevator deficiency

Yiping Wang, Junhong Li†(), Zhangqing Feng   

  1. Master′s degree 2021, First Clinical Medical College, Shanxi Medical University, Taiyuan 030001, China
    Strabismus and Pediatric Ophthalmology, Shanxi Eye Hospital, Eye Hospital affiliated to Shanxi Medical University, Taiyuan 030002, China
  • Received:2023-06-10 Published:2023-10-28
  • Corresponding author: Junhong Li
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王依平, 李俊红, 冯张青. 单眼上转不足的研究进展[J]. 中华眼科医学杂志(电子版), 2023, 13(05): 285-290.

Yiping Wang, Junhong Li, Zhangqing Feng. Research progress of monocular elevator deficiency[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2023, 13(05): 285-290.

单眼上转不足(MED)通常也称为双上转肌麻痹，是一种特殊类型的斜视，临床上根据病因和表现分为三种亚型。因三种亚型临床表现各不相同，手术方式需结合自身情况而定。近年来，减小术后残留斜视、降低二次手术率及减少术后眼前节缺血的并发症研究已成为热点。同时，又有部分学者集中关注于手术方式的改良与优化，从最初的Knapp术逐渐发展至增强Knapp术、改良Knapp术、Jensen术、Hummelsheim术、Nishida术、针对MED Ⅲ型并发水平斜视的转位联合术及直肌退截联合术。本文中笔者从MED发病机制和临床表现的角度进一步阐述其手术方式变革的研究进展，以期为个性化手术方案制定提供参考。

关键词: 单眼上转不足, 下直肌限制, 上转肌麻痹, 核上性上转麻痹, 上睑下垂, Knapp术

Monocular elevation deficit (MED) is commonly referred to as double elevator palsy, which is a special type of strabismus. It is divided into three subtypes through etiology and clinical manifestations. Because of their different clinical manifestations, the surgical approach often needs to be tailored. In recent years, to reduce postoperative residual strabismus, the rate of secondary operations and postoperative complications of anterior segment ischemia have been paid more attention. Meanwhile, many researchers have been focused on the continuous improvement and optimization in the surgical methods for MED, gradual development from the initial Knapp operation, including enhanced Knapp, modified Knapp, Jensen, Hummelsheim, Nishida, combined transposition and rectus dissection for MED Ⅲ type and concurrent horizontal strabismus. The latest research progress of surgical methods development in the term of the pathogenesis and clinical manifestations of MED was reviewed, aiming to provide a reference for the clinical design of more appropriate personalized surgery.

Key words: Monocular elevation deficit, Inferior rectus, Superior muscle paralysis, Supranuclear elevation palsy, Ptosis, Knapp′s procedure
表1 单眼上转不足的病因分型
病因分类 被动牵拉试验 主动收缩试验 Bell现象 垂直扫视速度
下直肌限制 (＋) (＋) (－) 正常
上转肌麻痹 (－) (－) (－) 减慢
核上性上转麻痹 (－) (－) (＋) 分离现象，中线以上异常或缺失，中线以下正常或降低
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