眼眶爆裂性骨折的影像特点与治疗方法

The imaging features and surgical treatments of orbital blow-off fractures

目的探讨眼眶爆裂性骨折影像学分析方法，指导临床工作，使治疗更合理和有效。方法回顾性研究2009年9月至2011年10月共收治的73例眼眶爆裂性骨折。其中男性59例，女性14例，平均年龄32．7岁。对患者的临床资料进行综合分析，认真阅读影像资料，注意骨折的性质、位置、范围大小以及眶腔容积的变化，关注眶内软组织、眼外肌与骨折缘的关系及其形态、位置变化等继发改变与临床表现的关系；制定治疗方案。结果手术患者62例，保守治疗患者11例。62例手术患者巾，眶下壁骨折39例可见开窗或凹陷性骨折及线性骨折，眶内壁骨折15例以凹陷性骨折居多，眶内、下壁骨折8例可见眶腔明显扩大，在CT影像检查中均看到眼外肌形状态、位置和眶内软组织的继发改变，并通过手术得到验证；对于2例儿童线性骨折有限外肌嵌夹、复视伴恶心呕吐者，采取急症手术治疗，所有手术患者均达到预期目的。保守治疗患者11例，效果较好。术后随访复查患者眼球内陷得到改善，限制性眼球运动障碍基本消除，影像学检查提示眶腔修复较好、软组织复位、填置物位置良好。结论认真分析影像资料表现，掌握治疗的适应证，把握手术治疗的时机，根据影像学表现松解粘连的眼外肌与影响肌肉运动的纤维机化条索，恢复眼外肌的功能，减少复视的发生率。

Objective To study CT imaging features of orbital blow-out fractures. Methods Ret-rospective study and analysis was made on the clinical records of 73 orbital blow-out fracture pa-tients from September 2009 to October 2011. Sixty-two cases with orbital fracture treated by surgi- cal treatments and 14 cases by conservative treatments were reviewed and summarized. The condi-tion in the diplopia, enophthalmos degree, eyeball position and imaging features were detected. The quality, position, and scope of fractures and the change of orbital cavity must be noticed, and under-stand the relation between orbital tissues or extraorcular muscles and fractures. Results Sixty-two cases were for operation, and 16 cases were for conservative treatment. The depressed, linear, and open fracture was seen in 39 cases of the fracture of inferior wall of orbit. Most fractures in the in-ternal wall of orbit were depressed fracture. The enlargement of orbital cavity was found in 8 cases of fractures of internal or inferior wall of orbit. The shape, position and secondary changes of extra- ocular muscles were detected by CT scan, which was confirmed by surgery. Even emergency opera- tions treatment should be taken to the children who had orbit linear fracture with the symptom of in- carcerated extraocular muscle, diplopia, nausea and vomiting. The conservative treatment for the pa-tients was effective. Conclusions It is necessary to master the treatment indications strictly, and to relax the adhesive extraorcular and fiber rope according to the imaging features, which can be effec-tive to recover the function of extraocular muscles and alleviate the diplopia of patients.