下睑结膜外眦入路在眶下缘和眶底骨折治疗中的应用

Clinical application of transconjunctival approach which combined with lateral canthus incision to treat fractures of the orbital floor and infraorbital rim

目的：探讨下睑结膜外眦入路在眶下缘和眶底骨折手术中的应用效果。方法：对24例眶下缘和眶底骨折采用下睑结膜外眦入路,将眶下缘骨折断端解剖复位后,用小钛板行眶下缘坚固内固定。合并眶底骨折者回纳疝出的眶内容物后钛网重建眶底,必要时植入充填材料矫正内陷的眼球。结果：24例患者术后伤口均I期愈合。术后随访6~36个月,除1例患者术后眼球内陷改善不明显外,所有患者无眼球运动障碍、复视、眶下区麻木。该组所有患者均未出现下睑外翻、下睑退缩,下睑外形良好,皮肤无明显瘢痕遗留。结论：与常用的睑缘下皮肤入路比较,下睑结膜外眦入路具有能充分暴露眶下缘、眶底骨折断端,防止下睑外翻、下睑退缩,术后瘢痕不明显等优点,是治疗眶下缘和眶底骨折较理想的手术入路。

Objective The aim of the study is to assess the means of transconjunctival approach which combined with lateral canthus incision to treat fractures of the orbital lfoor and infraorbital rim.Methods Total 24 patients who suffered from orbital lfoor and infraorbital rim using transconjunctival approach combined with lateral canthus incision.Fractures of infraorbital rim were repositioned and ifxed with titanium plate,and then ifnishing the reconstruction of orbital lfoor with restorative materials after reseted the orbital contents.Results All the incisions closed up in one stage.Except one patient whose enophthalmos improvement is not obviously,23 cases healed well without ectropion and other complications.Conclusion To compare with the common approach such as the lower eyelid incision,the transconjunctival approach which combined with lateral canthus incision can provide adequate exposure of surgical ifeld,this approach which is the ideal choice to treat fractures of the orbital lfoor and infraorbital rim can reduce the complication of ectropion and entropion without obvious scar.