内窥镜下修复近眶尖巨大内侧壁骨折临床观察

Clinical observation on endoscopic repair of large medial orbital wall fractures near the orbital apex

目的探讨内窥镜在近眶尖部的眶内壁骨折修复中的应用价值。方法近眶尖部的巨大眶内壁骨折40例，均经泪阜径路在鼻内窥镜下进行骨折修复。眶壁骨折范围在术中进行测量，以多孔聚乙烯板修补骨壁缺损。术后随访6～15个月。结果所有手术均顺利完成。在内窥镜直视下，所有嵌顿和疝出的眶内容均被松解和复位，骨折边界均被充分暴露，植入物均完全覆盖所有骨折边界。术后6个月，骨折缺损的解剖复位通过CT证实，双眼突出度对称者39例，占全组40例的97．50％，平均矫正（3．37±0．77）mm。原眼位30°复视的18例中16例得到矫正（88．89％）。2例（11．11％）向鼻侧注视时残余复视，分析可能为内直肌麻痹。1例术后1d眶内出血，保守治疗后恢复。纠论内窥镜下经泪阜修复眶尖附近的巨大眼眶内壁骨折，可以清楚显示骨折的边缘尤其是后缘，确保将补片精确覆盖在骨折边缘达到解剖复位，并发症少。

Objective To investigate the appilication value of endoscopy for repairing of large medial orbital wall fractures （MOWFs） near the orbital apex. Methods Forty patients with large MOWFs near the orbital apex underwent fracture repair under endoscopy through lacrimal caruncle pathway, and the range of the fracture was measured during the surgery. Porous polyethylene sheet was used to repair the bony i defects. Patients were followed up for 6 to 15 months. Results All surgeries were completed successfully. Under direct endoscopic visualization, all entrapped and herniated orbital contents were released and reset, the entire boundary of the fractures were exposed adequately, and the implants were placed to cover all edges of the fracture in all cases. The ranges of vertical and horizontal fracture defects measured during the surgeries were 16-30 mm and 25-34 mm respectively. Six months after the surgery, anatomical reduction of the bony defects was confirmed by orbital CT scans, and symmetry of the protopsis in both eyes was acquired in 39 of 40 patients （97.50%） , with a mean correction of （ 3.37 ±0.77 ） mm. Diplopia within 30° visual field of the gaze was resolved in 16 of 18 patients （88.89%）. Two patients （ 11. 11% ） had residual diplopia on medial gaze because of presumed paralysis of the medial rectus muscle. Intraorbital hemorrhage occurred in 1 patient at the first day after the surgery and resolved with conservative treatment. Conclusion The transearuneular endoscopy reparing seems to be a useful method for recovery of the normal anatomic features of the orbits in patients with large MOWFs near the orbital apex.