经结膜入路不缝合骨膜的眼眶骨折修复术疗效观察

Transconjunctival sutureless repair of orbital fracture

目的:探索经结膜入路不缝合骨膜修复眼眶骨折的手术方法的临床效果和临床可行性。方法:本研究采用回顾性调查,包括单纯性眶壁骨折51例,复合型骨折21例。采用经下睑结膜切口或经泪阜切口。探查并还纳嵌顿组织,根据骨折特点,采用羟基磷灰石复合材料或钛板、钛网修复眼眶骨折。所有病例均不缝合骨膜,结膜对合后,应用可吸收缝线缝合3针,然后缝合外眦韧带。观察术后各种并发症,包括结膜愈合状况;植入物暴露、感染和移位;外眦畸形;下睑退缩等。结果:所有病例术后平均随访4～18(平均11)mo,结膜切口愈合良好。其中3例出现外眦畸形,1例出现下睑内翻倒睫伴下睑退缩。无1例出现植入物暴露、感染和移位。结论:经结膜入路不缝合骨膜的眼眶骨折修复术术后发生并发症的几率较低,且无严重并发症,可以将该技术应用于单纯性和复合型骨折的临床修复。

AIM：To report the surgical outcomes of patients undergoing orbital fracture repair without periosteal closure·METHODS：All patients data were reviewed in a retrospective manner.Seventy-two patients（73 eyes） who underwent transconjunctival repair of isolated orbital fractures（n=51） or complex orbital fractures（n=21） without periosteal closure were included.A transconjunctival incision below the tarsus provided preseptal access to the inferior orbital rim,and transcaruncular incision provided access to the internal orbital fracture,after which the periosteum was incised for exploration and repair of orbital fracture.Forced ductions were performed after release of entrapped tissue and placement of orbital implants,and the periosteum was sutureless,conjunctiva was reapproximated with forceps and interruptedly sutured.Incidence of postoperative complications,including orbital implant exposure,infection,and migration was measured·RESULTS：All patients were followed up for 4-18（average 11） months postoperatively.One patient experienced lower lid retraction with entropion.Other complications included lateral canthal dystopia（n=3） or pyogenic granuloma at the lateral canthotomy site（n=1）.There were no cases of postoperative implant exposure,infection,or migration·CONCLUSION：Forgoing closure of the periorbita after transconjunctival orbital fracture repair is associated with a low incidence of postoperative complications.This technique is applicable in the repair of both isolated orbital fracture and complex orbital fracture.