应用自体耳甲软骨瓣重建眶底

Reconstruction of orbital floor with autogenous conchal cartilage graft

目的研究自体耳甲软骨瓣应用于眶底重建,对眶底骨折引起的复视和眼球内陷的疗效。方法自2003年7月～2007年6月应用耳甲软骨瓣重建眶底共21例。本组患者术前均经轴位和冠状位眶部CT证实存在眶底骨折下陷,且部分眶内容物疝入上颌窦,患侧眼球突出度与健侧相差3mm以上。自患侧耳廓切取耳甲软骨瓣(保留两侧软骨膜),经下眼睑下缘切口入路,用耳甲软骨瓣修补眶底骨质缺损。术后均随访3个月以上,观察复视和眼球内陷的治疗效果,以及供区耳廓有无畸形。结果本组21例患者术后复视消失者19例(90.5%)、明显改善者2例(9.5%);双侧眼球突出度相差≤2mm共17例(81.0%),2.1mm～3.0mm共3例(14.3%),>3mm共1例(4.7%);无一例出现耳廓畸形和耳甲软骨瓣感染。结论对于眶底骨折伴有眶底下陷,眶内容物疝入上颌窦以及双侧眼球突度相差明显的患者,应用耳甲软骨瓣重建眶底,可显著改善复视和眼球内陷等眼功能障碍,且不会引起供区耳廓畸形。

Objective To evaluate the effects of orbital floor reconstructions with autogenous auricular cartilage grafts for orbital floor fractures with enopthalmos and diplopia. Methods From July 2003 to June 2007, 21 patients with orbital floor fractures were performed the reconstruction surgery with the autogenous auricular cartilage grafts. All patients were diagnosed as orbital floor fractures according to the axial and coronal CT scans, which showed the bone disruptions and inferior displacements＇of orbital floors parts of the orbital soft tissues herniated into the maxillary sinuses, more than 3mm differences of exophthalmos of bilateral eyeballs. The conchal cartilage grafts （ with bilateral perichondriums reserved） were harvested from the affected side auricles through postauricular incisions. The comminuted orbital floors were reconstructed successfully with conchal cartilage grafts overlaping the bony defects through the subeihary incisions. All cases were followed - up for more than 3 months to evaluate the outcomes in improving enophthalmos and diplopia. Results Among the 21 patients, 19 patients （90.5%） with diplopia were corrected, another 2 patients （9.5%） were improved significantly. Meanwhile, the differences of enophthalmos of bilateral globes of 17 patients （81.0%） were less than 2mm, only 1 patient （4.7%） was more than 3mm, the other 3 patients （ 14.3% ） ranged from 2. 1mm to 3mm. None of the donating auricles were deformed postsurgically. The patients all recovered uneventfully. Conclusion The reconstruction surgery with autogenous conchal cartilage graft can be performed for orbital floor fracture with disruption and inferior displacement of orbital floor, the herniating of orbital soft tissues into maxillary sinus associated with significant differences of exophthalmos of bilateral eyeballs.