外伤性眶内血肿的影像学诊断和治疗原则的建议

The imaging diagnosis and the opinion on therapeutic principle for traumatic orbital hematoma

目的探讨外伤性眶内血肿的影像学诊断价值和治疗原则。方法8例行眼眶轴位和冠状位CT扫描,部分病例再行眼科B超扫描或MRI检查。治疗方法:眼球突出进行性加重、眶压急剧增高、视力急剧下降或丧失者,行开眶手术并引流;晚期就诊,眼球突出明显、眼球运动障碍者,在B超引导下穿刺抽出已液化的积血;轻度突眼、眶内压增高不明显、视力未受影响者,给予冷敷、加压包扎和止血剂等保守治疗。结果CT显示血肿位于眶顶骨膜下者居多,显示为边界清楚、密度较均匀的高密度影。超声显示早期血肿边界清楚、内回声不均匀,晚期血肿为无回声液性暗区。MRI检查晚期血肿T1及T2加权像均显示为高信号区。治疗后视力下降者中,2例24h就诊者视力恢复正常,1例3d就诊者视力由0.2提高到0.5,1例16d就诊及1例视力丧失者视力无改善。结论建议CT作为外伤性眶内血肿的首选早期诊断方法。根据就诊时间和病情的不同采取开眶引流、穿刺抽血或冷敷加压等治疗方法。。

Objective To approach the diagnosis values of the imaging and the principle of treatment of traumatic orbital hematomas. Methods Axial and coronal CT were performed in the cases with traumatic orbital hematomas, US and MRI were performed to some of them. Treatment： 1, The patients who had progressive aggravated eye-tubercle, the orbital pressure increased rapidly, and vision decreased rapidly or lost, were given operations to decompress and drain. 2, The patients who visited after a few days, had obviously eye-tubercle and handicap of ocular movement, were given pricking to draw out the liquefactive hematocele under the guide of US. 3, The patients who had a little eye-tubercle, slight increase of the orbital pressure, non-effected vision, were given cold compress, pressure dressing and hemostatic. Results CT showed the most common location of the hematomas was subperiosteum of the orbital roof, most were high-density shadows with clear boundary and steady densities. US showed the earlier period hematomas had clear boundarys and uneven intra-echos, the advanced stage hematomas showed fluidity echofree space. MRI of the advanced stage hematomas showed high signals in both T1 and T2 weight. After treated, Among the 4 patients with decrease of their vision, 2 patients who visited within 24 h got normal vision, one patient who visited within 3 days improved his vision from 0. 2 to 0.5, one patient who visited after 16 days didn＇t improve his vision. One patient who had lost his vision didn＇t save his vision after treatment. Conclusion CT may be taken as the chief method to diagnose traumatic orbital hematoma. Different treatments, such as operation and drain, or pricking and hemospasia, or cold compress and pressurize, should be given considering the different visit time and conditions. So we can obtain content curative effect.