额眶区复杂开放性损伤的Ⅰ期手术治疗

Stage Ⅰ surgical treatment for the complex open orbitofrontal injury

目的探讨额眶区复杂开放性损伤的Ⅰ期手术治疗方法及临床效果。方法回顾性分析23例额眶区复杂开放性损伤患者的临床资料。23例患者均接受了Ⅰ期清除颅内血肿和坏死脑组织、颅底重建修补、颅眶畸形矫正、视神经探查,其中13例行视神经管减压。结果按格拉斯哥预后量表(GOS)评分和面部整形评价标准,术后6个月GOS 5分14例,GOS 4分7例,GOS 3分2例。17例达到整形标准优秀级,6例达到良好级。术后无永久脑脊液漏,视神经管减压后视力不同程度改善。结论额眶区复杂开放性损伤,病情复杂,通过多学科联合手术,Ⅰ期清除颅内血肿和坏死脑组织、颅底重建修补、颅眶畸形矫正、视神经管减压,外形结构和功能均可获得良好的临床效果。

Objective To explore the stageⅠsurgical treatment and clinical effects about the complex open orbitofrontal injury .Methods The clinical data of 23 patients with complex open orbitofrontal injury were analyzed retrospectively .All patients were underwent stageⅠoperations of removed of intracranial hematoma and necrotic tissue , reconstructed the cranial base , corrected malformed cranial-orbital bone and probed optic nerve , 13 of them were underwent the optic canal decompression .Results According to Glasgow Outcome Score （ GOS） and the evaluation standard of facial plastic surgery , 6 months after the operation ,of 23 patients,14 were recovered well ,7 moderate disabled ,2 severly disabled .17 patients achieved excellent level of facial plastic , 6 good level . Postoperation no permanent cerebrospinal fluid leakage were found and eyesight improved in different extent after optic canal decompression .Conclusion The complex open orbitofrontal injury need multidisciplinary joint surgery to remove intracranial hematoma and necrotic tissue , reconstruct the cranial base , correct malformed cranial-orbital bone and optic canal decompression .These surgery can make the outside structure and function acquiring a good clinical effect .