鼻内窥镜下纸板击出性骨折复位术

The lamina papyracea fracture reduction under nasal endoscope

目的 评价鼻内窥镜下纸板击出性骨折复位术的临床疗效。方法 对 6例伴有眼球凹陷、睑裂变小及复视等症状、眶部CT(水平 +冠状 )扫描均显示纸板击出性骨折的患者 ,在确定骨折位移程度及范围后 ,在局部麻醉 +鼻粘膜表面麻醉下行鼻内窥镜经筛窦纸板骨折复位术 ,手术采用常规Meeserklinger入路 ,小心咬除骨折区筛房 ,显露骨折区纸板 ,用钝性剥离子 ,由前向后将内移的纸板外推复位 ,局部碘仿纱条填塞支撑 ,2～ 3周去除填塞纱条。结果 术后 6例均消除了眼球凹陷及复视 ,无并发症发生。经 0 .5～ 2年随访 ,眼球凹陷均稳定在 2mm以内。结论 鼻内窥镜下纸板骨折复位术具有入路简捷 ,操作简单 ,眶内侵袭少 ,无面部疤痕等优点 ,效果确切。是治疗纸板骨折较为理想的术式。

Objective To evaluate the clinical results of blow out laminapapyracea fracture reduction under nasal endoscopy.Methods All 6 cases had endophthalmos and blepharophimosis. Four cases also complained of diplopia. The horizontal and coronal CT of orbit showed the lamina papyracea fracture clearly.The degree and range of the lamina papyracea displacement was measured on CT films.The reduction under nasal endoscope was performed with local and topical anesthesia. We selected the Meeserklinger's route of entry.The uncinate process,ethmoidal bulla,and ethmoidal cells were removed successively.Then,with the help of a tonsil dissector, the lamina papyracea was pushed outward and replaced and was supported with iodoform gauze.After 2 to 3 weeks,the gauze was removed.Results The endophthalmos and diplopia disappeared in all cases. No postoperative complications occurred. With 0.5～2 years follow up,the degree of the endophthalmos was stable within 2 mm. Conclusion The reduction under nasal endoscope has many advantages such as short route of entry,simple performance, and no facial scar. It is a good operative option to correct the lamina papyracea fracture.