颅内外联合入路矫治严重额眶骨折后遗畸形

Intro-extro cranial approach treat serious post fronto-orbital fracture deformities

目的 探讨颅内外联合入路治疗额眶骨折后遗畸形的有效方法。方法 根据有无大块骨质缺损将额眶骨折主要分为两类 :①额眶部大块骨组织缺损。②额眶部骨折塌陷 ,无大块骨组织缺损。二者均经颅内外联合入路充分显露骨折部位 ,前者主要采用自体颅骨外板及人工骨行额眶部骨缺损的修复重建 ,后者则运用截骨复位、小钛板坚强内固定、植骨等颅颌面外科技术修复。结果 1998年 6月～ 2 0 0 0年 10月 ,共治疗额眶骨折后遗畸形 18例 ,其中同时合并大块骨组织缺损者 12例 ,额眶部骨折塌陷 ,无大块骨组织缺损者 6例 ,所有患者畸形明显改善 ,外形及功能恢复良好。结论 颅内外联合入路较单纯颅外入路更能清晰显露额眶骨折的部位 ,便于手术操作 ,与颅颌面外科各项技术灵活结合 ,可收到良好的手术效果。

ObjectiveTo explore the method of treating serious secondary fronto-orbital fracture deformities through intro-extra cranial approach. Methods The fronto-orbital fracture was divided into two types according to whether there were any large scale fronto-orbital bone defects: typeⅠ:Large scale fronto-orbital bone defect ; typeⅡ: Concave fronto-orbital fracture deformity without large scale bone defect. Both types were treated through intro-extra cranial approach to expose the fracture site. For typeⅠdeformity, the bone defects were repaired and reconstructed with outer table of cranial bone and artificial bone. For typeⅡ,the deformity was repaired by osteotomy, bone reposition and internal rigid fixation. Results 18 cases were treated from June 1998 to October 2000, include type I, 12 cases, and typeII, 6 cases. All the patients recovered well and the post-operative appearance were greatly improved. Conclusions Intro-extra cranial approach can expose the fractured site better than the simple extrocranio approach, and make the operation more easily done. Combined with the technique of cranio maxillo facial surgery, the treatment can be more complete and the results can be more satisfactory.