鼻内镜下眶内壁损伤的自体组织修复

Endoscopic Endonasal Repair of Medial Orbital Wall Bust Fracture with Autograft

目的：探讨经鼻内镜手术治疗眼眶击出性骨折的治疗效果。方法：对该院从2002年2月～2003年3月收治的，8例临床及CT扫描提示眼眶内壁击出性骨折的患者，进行了鼻内镜下眶内壁损伤修复术。手术均在局部麻醉鼻内镜下进行，常规由前向后入路切除钩突、开放筛窦，小心清理筛房破碎骨片、凝血块，还纳眶内容物，同时牵拉内直肌。采用硅胶片、鼻中隔软骨、带蒂中鼻甲或纸板非游离骨片修复眶内壁。结果：病人术后随访半年。6例采用自体组织修复者一次手术成功，1例采用硅胶片修复者，术后半个月时置入的硅胶片脱落；1例采用纸板非游离骨片修复者，取出敷料后，内容物又反弹入筛窦。这两例均重新采用鼻中隔软骨修复成功。结论：经鼻内镜行眶内壁损伤修复术有很多优点，建议采用自体组织进行修复。

Objective： T surgery of nasal endoscopy. scan evidence suggestive of o evaluate the treatment effect Methods： Eight patients with c medial orbital wall bust fracture of the orbital bust linical and computed fracture by tomography were treated by surgery of nasal endoscopy in our department from February, 2003 to March, The surgery was preformed with 4-mm endoscope under local anesthesia. The uncinate was removed. The ethmoid sinuses were opened. The debris, blood, sinus mucosa were removed. Then the impacted orbital lipid and medial rectus in the ethmoid sinus were pushed into the orbit, and the defect were repair with silicon, cartilage of nasal septum, middle nasal turbinate with pedicle or reserved nonfree papyracea. Result： The patients were followed up for 6 month. Six cases, which repaired with autograft, got success at their first attempt. The implant displacement and fall out in one case that repaired with silicon. The orbital content came back in the ethmoid sinus again in one case that repaired with reserved non-free papyracea. The latter two cases underwent repaired again with the cartilage of nasal septum without implant displacement or recurrence. Conclusion： There are many advantages with endoscopic transantral approach for the orbital bust fracture repairing and the autograft repairing is recommended.