眼性斜颈临床误诊分析.docVIP

眼性斜颈临床误诊分析 　　[摘要]目的：分析眼性斜颈误诊病例，探讨眼性斜颈的误诊产生原因及鉴别诊断。方法：回顾性分析我科1994年～2006年12年间收治的被误诊为肌性斜颈的眼性斜颈病例，并对其眼科诊断分类与治疗进行分析。结果：共有37例眼性斜颈病人曾在外院被误诊为肌性斜颈，其中先天性上斜肌麻痹或不全麻痹的24例，占64.9%；先天性上直肌麻痹的8例，占21.6%；先天性下直肌麻痹的3例，占8.1%；先天性下斜肌麻痹的2例，占5.4%。曾在外院作过胸锁乳突肌手术的21例，占56.8%；作过理疗等保守治疗的16例，占43.2%。结论：在误诊为肌性斜颈的病例中，先天性上斜肌麻痹占大多数；临床医生应注意区别先天性肌性斜颈与眼性斜颈，以免延误治疗。 　　[关键词]眼性斜颈；误诊 　　[中图分类号]R776.1[文献标识码]A [文章编号]1008-6455（2008）08-1141-02 　　 　　Analysis of the ocular torticollis cases misdiagnosed as muscular torticollis 　　LIU Yan,WANG Wei-nong,YAN Hong 　　(Department of Ophthalmology, Tangdu Hospital of the Fourth Military Medical University, Xian 710038,Shaanxi,China) 　　 　　Abstract: ObjectiveTo investigate the cause of the misdiagnosis by analyzing the cases of ocular torticollis misdiagnosed as muscular torticollis.MethodsThe ocular torticollis cases misdiagnosed as the muscular torticollis in other hospitals from 1994 to 2006 were retrospectively analyzed, and the diagnostic classification and the treatment were analyzed.ResultsThere were 37 ocular torticollis cases misdiagnosed as the muscular torticollis. Of them,there were 24 cases of congenital superior oblique palsy or paresis, accounting for 64.9%. 8 cases of congenital superior rectus palsy,21.6%. 3 cases of congenital inferior rectus palsy,8.1%. 2 cases of congenital inferior oblique palsy, 5.4 %. There were 21 cases by the surgery of sternocleidomastoid muscle, accounting for 56.8%. 16 cases by physical therapy or other conservative treatment, 43.2%.ConclusionCongenital superior oblique palsy or paresis is the disease most commonly misdiagnosed as muscular torticollis, so clinicians should distinguish the ocular and muscular torticollis in order to avoid making the misdiagnosis or delaying the treatment. 　　Key words: ocular torticollis; misdiagnosis 　　 　　斜颈是临床上较常见的一种疾病，以歪头为主要表现。先天性斜颈???分为肌性斜颈、骨性斜颈、眼性斜颈。其中以肌性斜颈多见。在临床上，因眼肌麻痹而导致眼位不正进而出现的斜颈称眼性斜颈。因临床医生的疏忽，有时，会将眼性斜颈误诊为肌性斜颈。本文回顾了我科1994年～2006年间收治的被误诊误治为肌性斜颈的眼性斜颈病例，并作了分析，以期为临床医生提供参考。 　　 　　1临床资料