鼻骨-眶-筛骨骨折的手术治疗

Surgical management of naso-orbital-ethmoid fractures

目的探讨鼻骨-眶-筛骨(NOE)骨折的临床特点、治疗原则及手术方法。方法2000至2003年北京大学口腔医学院口腔颌面创伤中心收治29例NOE骨折(单纯NOE骨折2例、合并颅面其他骨折27例),临床典型表现为内眦间距增宽、鼻畸形、眼球内陷或下陷伴复视。手术治疗包括骨折复位、眶壁缺损重建、内眦韧带悬吊和鼻成形。术后对眼球内(下)陷和复视的改善情况和NOE区形态指数进行评价。结果术后3～6个月复查率48.27%。术后感染率10.35%。14例眶壁修复术后,9例眼球内(下)陷得到矫正,5例显著改善;13例内眦韧带悬吊术后,内眦畸形明显改善;4例术后出现慢性泪囊炎,摘除泪囊或行内鼻腔泪囊吻合术。22例手术前后形态测量值及相关指数比较术后内眦间距变小、内眦处鼻梁矢状高度增大,鼻根指数接近正常值、睑裂对称指数97.5%、内眦处鼻梁矢状高度对称指数89.7%。结论根据畸形特征采用多种术式组合治疗NOE骨折,多数可取得较满意的效果,但存在较大的不确定性,对眼球内陷和内眦畸形的手术矫治方法还有待进一步研究和改良。

Objective To explore the clinical characteristics of naso-orbital-ethmoid （NOE） fracture, principles and surgical methers. Methods Twenty-nine patients with NOE fractures were investigated, operations for the treatment of NOE and subsequent deformities included reduction of central fragment , reconstruction of orbit walls, reattachment of medial canthal ligament and so on. The outcome of the treatment was evaluated. Results Three cases were infected postoperatively. Of the 14 cases performed on reconstruction of orbit wall, 9 cases got complete correction for their dystopia/endophthalmos, 5 cases improved. Thirteen cases experiencing canthopexy obtained accepted outcome. Conclusions The satisfactory correction of NOE fracture and subsequent endophthalmos/dystopia and telecanthus can be achieved with elective surgery in most cases.