经结膜切口入路行颧眶复杂骨折治疗的临床应用

Clinical application of transconjunctival approach to treat orbitozygomatic complex fractures

目的评价经结膜切口入路行颧眶复杂骨折手术的效果。方法对46例54例颧眶复杂骨折，采用结膜切口入路并向外眦延伸5～10mm，43例附加口腔前庭黏膜切口，将骨折断端解剖复位后，采用钛板进行眶缘坚强内固定，钛网进行眶底粉碎性骨折的重建。结果46例颧眶复杂骨折患者术后左右颧部基本对称，眼球位置解剖复位，效果满意。术后无明显不良并发症，仅1例出现右侧角膜上皮剥脱，1例出现结膜水肿消退延迟，经用药后均恢复正常。结论经结膜切口入路能充分暴露颧眶复杂骨折，避免了面神经损伤、面部瘢痕等并发症，是治疗颧眶骨折的较好的手术入路。

Objective To evaluate the effective of transconjunctival approach in treating orbitozygomatic complex fractures. Methods Fifty-four transconjunctival incisions were applied to correct enophthalmos and face collapse in 46 patients who suffered by orbitozygomatic complex fractures. All operative procedures were performed with an additional lateral canthotomy（5-10 mm） and 43 of them with gingivobuccal sulcus incisions simultaneously. The infraorbital rim and lateral orbital wall were stabilized with titanium plates. Titanium nets were used to reconstruct the comminuted orbit floor fractures. Results The bilateral zygomaticas of 46 cases with orbitozygomatic complex fractures were basically symmetric, and the eyeball positions were reset anatomically. The treatment effectiveness were satisfactory. There were no obvious postoperative complications, except one corneal epithelium stripped on the right side and one overtime swelling of conjunctiva which cured after relevant treatments. Conclusion The transconjunctival approach has good exposure to the orbital floor without visible scar and injury to facial nerve branches, it is a preferable procedure to reconstruct orbitozygomatic fractures.