眼眶爆裂性骨折临床诊疗分析

The clinical features and treatment of orbital blowout fracture

目的探讨眼眶爆裂性骨折的临床特点和治疗方法。方法对32例32只眼眼眶爆裂性骨折伴复视及眼球运动障碍者进行回顾性分析。眼眶CT显示:眼外肌、眶内软组织嵌顿眶内壁或眶下壁骨折区。伤后观察2周,复视及眼球运动障碍无明显改善者选择手术。全麻下根据眶壁骨折的部位,采取相应下睑缘下切口(眶底骨折)、内眦皮肤切口(眶内壁骨折)或两切口联合入路(眶内下壁骨折),将嵌顿于骨折处或鼻窦腔内的眼眶组织复位,再根据骨折的范围植入适当大小的Medpor填充物。随访3个月至1年。结果 23例眼球运动恢复正常,9例仍有不同程度的复视。23例眼球内陷得到充分矫正。结论眼眶爆裂性骨折患者可存在复视及眼球内陷,CT扫描和牵拉试验均有明确的眼外肌嵌顿,保守治疗2周无好转,即应手术。

Objective：To evaluate the clinical features and treatment of orbital blowout fracture. Methods： 32 eye of 32 cases with orbital blowout fractures associated with diplopia and eye movement disorders in our hospital were reviewed retro- spectively. Orbital CT display extraoeular muscles and orbital soft tissue were incarcerated into medial wall or orbital floor fracture zone. After 2 weeks observation,there was no significant improvement with diplopia and eye movement disorders. Under general anesthesia, Infraorbital incision,inner eanthal skin incision or combined incision was done according to the orbital wall fracture site. Incarcerated tissues in maxillary sinus were replaced. The appropriate Medpors were implanted ac- cording to the size of the fracture. Followed up from 3 months to 1 year. Results ： Eye movement in 23 cases were normal. 9 patients still suffered from diplopia. Enophthalmos in 23 eases were fully restored. Conclusions ： Diplopia and enophthal- mos were main complains in orbital blowout fracture patients. CT scans and traction test clearly displayed incarcerated ex- traoeular muscles. Operation must be done after 2 weeks obversation without improvement.