眼眶骨折修复术的临床疗效分析

The clinical analysis on the method and effect of repairing surgery for orbital fracture

目的分析眼眶骨折患者的手术方法及效果。方法对96例（96眼）眼眶骨折的临床表现、治疗方法和效果进行回顾性分析。结果96例术后均未发生填充材料移位、脱出、感染或排斥现象，无术后视力下降者。94例（97．92％）术后眼球内陷得到完全矫正，2例（2．08％）欠矫1～2mm，眼球突出度均较术前提高1．5—3．5mm；85例（88．54％）术后复视完全消失；8例（8．33％）复视有明显好转，第一眼位无复视，仅在眼球极限运动时有复视存在；3例（3．13％）术后复视部分改善，1年后行斜视矫正术。术后早期出现球结膜水肿27例，眶内出血2例，均于两周内恢复正常。眶下神经支配区感觉较术前减退者11例，3个月后复诊9例恢复正常，2例出现永久性损伤。结论眼眶骨折修复术应根据骨折情况及部位，选用合适的手术进路和填充材料，修复眼眶骨折和恢复眶腔容积。早期手术的疗效优于晚期手术。

Objective To analyse the method and effect of repairing surgery for orbital fracture. Methods Clinical manifestations and treatments of 96 cases of orbital fracture were analyzed retrospectively. Results Postoperative displace, prolapse, infection, rejection or visual decrease were not observed in the 96 cases. Enophthalmos was corrected completely in 94 cases （ 97. 92% ） and under- corrected by 1 ~2 mm in 2 cases （2.08%） after surgery. Exophthalmos was corrected by 1.5 ~ 3.5 mm compared with preoperation. Diplopia was alleviated obviously in 8 case （ 8. 33% ） without diplopia in primary eye position, except for the condition of eyeball maximal exercise ; and was corrected completely in 85 cases （88.54%）; Diplopia was alleviated partially in 3case （3. 13% ） and after one year the strabismus correction was adopted. Early ehemosis after operation was observed in 27cases, and orbital hemorrhage was found in 2 cases. All cases returned to normal situation within 2 weeks. Decreased sensation of infraorbital nerve innervation existed in 11 cases, with returning to normal situation in 3 months in 9 cases and permanent damage in 2 cases. Conclusion The suitable approaches and orbital implants can be selected according to its fracture condition and location to repair the orbital fracture and recover the orbital cavity volume. The curative effect is better in the early phase of orbital fracture than in the late phase. The key points of eliminating diplopia are to release the blocked extraocular muscles, strengthen the early functional exercise of eyeball and prevent re-eonglutination of extraocular muscles.