复合性眶周骨折的综合修复探讨

Comprehensive repair of complex periorbital fracture

目的 探讨复合性眶周骨折的综合修复方法.方法 根据患者骨折的解剖结构、症状、外形及创口特点,应用表面微小切口或冠状切口,松解复位后,以钛板坚固内固定颅颌眶骨,辅以预成型钛网、羟基磷灰石修复骨缺损;对于继发鼻畸形者,可Ⅱ期鼻整形修复;对于伴眼内容物创伤者,联合眼科行肌肉松解、眶内衬垫填充法眶壁修补术;对于严重的眼球损伤,则由眼科医师行眼内容物剜除＋义眼台植入术;对于伴发内眦韧带断裂致眼角变形者,手术探查内眦韧带并将之固定于鼻嵴相应处或Ⅱ期行眼角开大术,同期请眼科医师探查泪道损伤;对于伴发眶尖综合征或眶上裂综合征者,联合神经外科进行手术或通过Ⅱ期手术矫正上睑下垂.结果 本组共28例患者（32只眼）,术后随访3～12个月.1例伴发眶尖综合征患儿术后仍存在轻度上睑下垂,2例眼球内陷患者术后仍存在眼球突度不对称,1例伴发低鼻歪鼻患者术后仍存在轻度的歪鼻畸形;其余24例患者外形较满意,眼睑及眼球运动自如,眼球突度对称,复视消失,鼻部及面形良好.结论 对于复合性眶周骨折的修复,既应对局部进行针对性骨折片复位,又需考虑整体进行综合修复,以达到最佳的治疗效果.

Objective To discuss the operation technique of comprehensive repair of complex periorbital fracture.Methods According to patients＇ anatomical structure of fracture,symptoms,appearance and the characteristics of wounds,we repaired by using under superficial micro-incision or coronal incision,then bone defects were released and replaced and then the cranio-maxillary bone fracture was fixed with titanium plate accompanied by performing titanium mesh and hydroxyapatite; For secondary nose decormity,rhinoplastyin at second stage was carried on.For patients with wound of optical content,the treatment was performed with muscle releasing and orbital wall repairing of the intraorbital filling; For patients with angular decormity caused by rupture of medial palpebral ligament,the medial palpebral ligament was explored and fixed it to the corresponding place on nasal crest or epicanthalplasty at second-stage was adopted,the ophthalmologists were invited to ex plore lacrimal duct damage at the same time.For patients with orbital apex syndrome or superior orbital fissure syndrome,the operation was performed together with neurosurgeons or correoted ptosis at the second-stage.Results Follow-up was performed on 28 patients （32 eyes） for 3 to 12 months after operation,all were satisfied with good appearance,the movement of eyelids and eyeballs,the symmetrical protrusion degree of eyeballs,disappeared diplopia and good contours of nose and face except one combined with apical orbital syndrome suffered from mild ptosis,two were with asymmetrical protrusion degree of eyeballs and one combined with mild deviated nose deformity was still with slight deviated nose after operation.Conclusion To repair complex periorbital fracture,the optimal treatment outcome could be achieved by both restoring local fracture debris and undergoing comprehensive repair for overall consideration.