摘要
目的 探讨头外伤而非眼球直接受伤后眼眶骨折导致眼球突出的形成机制、临床特点、诊断和治疗方法 . 方法 回顾性分析头外伤后眼眶骨折致眼球突出的13例患者（14眼）的致伤原因、临床表现、形成机制、骨折类型、手术时机、手术方式及疗效.术前行眼眶螺旋CT薄层扫描及三维重建,根据骨折部位选择适当手术人路整复骨折或去除骨折片,术后随访. 结果 患者均存在不同程度的颅脑损伤,尤以前额受损为主（12例）.共14只眼球发生突出,术前平均突出度为（2.94±0.47）mm;8例眼球突出方向为向外下,5例为向前下方.眼眶骨折位于眶上壁或（和）内侧壁,均为眶壁向眶内骨折.手术过程顺利,术后眼部症状迅速消失,无死亡及重度残废病例. 结论 头外伤时发生的局部颅骨变形及脑组织移动是导致眶壁向眶内骨折的主要原因,进而使眶内容积变小发生眼球突出.螺旋CT检查对其诊治和随访具有重要意义.应早期手术治疗,效果良好.
Objective To study the mechanism, clinical characteristics, diagnosis and treatments of orbital fracture-induced exophthalmos after craniocerebral injury. Methods We retrospectively analyzed the data of 13 patients with orbital fracture-induced exophthalmos after head injury： their causes of injury, clinical situations, types of fracture, operative treatments and surgical outcomes. Spiral CT thin slice scan and three-dimensional reconstruction were performed on the orbit before any treatment, and then, orbital fractures were repaired by corresponding surgical approaches according to the position of fractures and head injury. The effect of operation was evaluated by spiral CT and follow up was performed. Results The patients obviously manifested as having craniocerebral injury and 14 eyeballs in 13 patients had exophthalmos. The average preoperative degree of protrusion was （2.94±0.47） mm.The axial spiral CT together with the reconstructive picture presented the pre- and pro-operative orbital fractures clearly. Orbital fracture positions were situated at superior and medial wall of the orbit. All operations were succeed without death or severe disability. Conclusion The diversify of intracranial pressure is the main reason of orbital fractures which shrinks towards the inter orbit to its volume and induces exophthalmos after craniocerebral injury. The spiral CT examination has vital significance in the diagnosis and treatment of orbital fracture-induced exophthalmos and the patients can obtain good outcome by early surgery.
出处
《中华神经医学杂志》
CAS
CSCD
北大核心
2010年第5期530-532,共3页
Chinese Journal of Neuromedicine
