眼眶骨折修复手术后残余复视的手术矫正

Correction of the Remanent Diplopia after Orbital Fracture Repair

目的探讨眼眶骨折修复手术后主要功能视野内消除复视的手术时机、方法和效果。方法筛选眼眶骨折修复手术后，对残余复视进行手术矫正的40例患者进行回顾性研究。分析不同患者复视的成因，手术时机及手术方法的选择。术后随访6个月对手术疗效进行评价。结果眼眶骨折修复手术后存在Ⅲ级复视患者40例，均施行眼外肌手术。根据眼肌检查及被动牵拉试验结果，选择直肌后徙悬吊、截除以及Jensen联结、眶骨膜固定等术式。术中25例角膜映光基本正位，主要功能视野内无复视；15例仍存在Ⅲ级复视。术后观察6个月，27例主要功能视野无复视；13例仍存在Ⅲ级复视，其中7例正前方无复视，但下方视野残留复视，6例第一眼位残留复视，给予配戴压贴三棱镜后复视改善。结论眼眶骨折修复术后消除主要功能视野复视的手术方法应根据术前和术中牵拉试验以及眼球运动等眼肌检查结果来选择，合理的手术方式可有效地消除复视、改善眼球运动功能。

Objective To investigate the occasion, method and effectiveness of the diplopic correction after the orbital fracture repair.Methods This was a retrospective observational study of 40 patients with remanent diplopia after the reconstructions of orbital fractures.The different cause, operational occasions and surgical techniques were analyzed.All patients were followed for a period of 6 months following the surgeries. Results The patients with III degree diplopia were all performed the operations on extraocular muscles.Different operation was selected to different patient according to the examinational results of the extraocular muscles and passive drawer test, including rectus retropulsion, suspension, excise, Jensen＇ s connection and fixation to periorbital membrane.During the surgery, 25 cases had no diplopia in mainly functional visual fields, while 15 cases still had Ⅲ degree diplopia.After 6 months, 27 cases had no diplopia in mainly functional visual fields, while 13 cases still had Ⅲ degree diplopia.Among these 13 cases with Ⅲ degree diplopia, 7 cases had no the diplopia of primary position of eye, and 6 cases had the diplopia of primary position.These 6 patients were suggested to wear the triangular prisms for improvement of the diplopia.Conclusions The operations should be selected according to the examining results about eyeball movements and diplopia before and during the surgeries.Reasonable operations could correct diplopia and improve the eyeball movements effectually.