单纯型眶壁爆裂性骨折早期手术治疗的效果

Effect of early surgical treatment for orbital pure blow-out fractures of orbital wall

目的 探讨单纯型眶壁爆裂性骨折早期手术治疗的方法和效果.方法 2007年1月至2013年7月,对33例（36只眼）单纯眶壁爆裂性骨折患者行修复手术治疗.应用三维CT扫描技术,明确眶壁骨折情况和特征,采用下睑睫毛缘下皮肤入路显露眶壁骨折的部位,回纳眶内容物后,采用自体骨或高密度多孔聚乙烯（Medpor）仔细填充修复眶壁缺损.结果 33例术后随访3～12个月,未出现植入骨感染、外露等并发症,眶、眼睑外形良好,眼球运动功能恢复,复视均消失.29例双侧眼球突度对称,4例患侧眼球轻度内陷.结论 眶壁爆裂骨折使眶腔容积增大、眶内容物疝出,还纳眶内容物后修复眶壁恢复眶腔容积,是治疗的最有效方法.早期CT检查是明确诊断的必要方法,对眶壁爆裂性骨折应尽早手术治疗,以避免发生并发症.

Objective To explore the therapeutic methods and effects of orbital blow-out fractures.Methods Thirty-three cases （36 eyes） of orbital pure blow-out fracture were treated by surgery from January 2007 to July 2013.The features of orbital fractures were determined with three-dimensional computed tomography scans.The area of fractures was exposed through sub-ciliary incision,the herniated orbital contents were released and reduced to the orbital cavity.The fractured orbital walls were repaired precisely with autologous bone or Medpor.Results After 6 to 12 months followup,there were no serious complications such as infection of bone graft,exposure of implants in all 33 cases,and all the cases got satisfactory appearance of eyelids and orbit,of which the diplopia disappeared and eyeball movement function recovered normally.The protrution of eyeball in 29 cases were symmetrical,but 4 cases presented mild enophthalmos at affected side.Conclusions The orbital volume enlarges and orbital content herniating into paranasal sinuses is caused by orbital blow-out fracture.Implanting autogenous grafts and Medpor to restore orbital volume are proved to be effective.Early CT examination is an effective method for the diagnosis.In order to avoid complications,the orbital blow-out fracture should be subjected to surgical treatment as soon as possible.