眼球萎缩合并眼眶—上颌骨—颧骨骨折的手术治疗

Surgical treatment of eyeball atrophy and complicated fracture of OMZ

目的:探讨重度眼球破裂伤后眼球萎缩合并眼眶-上颌骨-颧骨(orbital maxillary zygomatic OMZ)骨折手术时机及手术方式,解决由于上述原因所致的眼窝凹陷,伤侧面部畸形,开口受限等。方法:伤后1~3wk行改良眼内容物去除术联合羟基磷灰石义眼座植入术,术后1~2wk行头皮冠状切口,下睑袋切口和口内龈颊移行切口入路进行骨折复位,钛钉、钛板内固定并用高密度多孔聚乙烯材料修整塑型后填充眶壁骨折缺损区。结果:经过3mo^3a随访,17例病例均取得满意效果。结论:眼球萎缩合并眼眶-上颌骨-(或)颧骨骨折患者伤后早期行改良眼内容物去除术联合羟基磷灰石义眼座植入术,术后1~2wk无感染及义眼台暴露情况下行OMZ骨折修复术,疗效确切,无植入物移位排斥,感染等并发症。

AIM： To discuss the operative opportunity and surgical approach on patient with eyeball atrophy and complicated fracture of orbital maxillary zygomatic （OMZ） caused by severe eyeball rupture to solve eye-socked depression, face abnormality or restriction on opening of mouth on wounded side and trismus and so on caused by above reason. METHODS： One week to 3 weeks after wounded, patient was treated by improved enucleation （ removal of the eye） combined with orbital hydroxyapatites ocular implantation. 1 week to 2 weeks after operation, fracture was reduced by incision of coronal, incision of lower eyelid bag and incision of mucogingival junction and was internal fixed with titanium screw or plate. Then porous was inserted after reconstruction. RESULTS： After 3 months to 3 years follow-up, all 17 cases were treated successfully. CONCLUSION： The early application of improved enucleation （removal of the eye） combined with orbital hydroxyapatites ocular implantation is effective for patients with eyeball atrophy and complicated fracture of OMZ, and no complication is found such as dislocation of the implant, rejection and infection.