眶爆裂骨折CT影像学诊断与外科治疗的价值探讨

The Diagnostics of CT and Surgical Therapy for Orbital Blowout Fractures

【目的】探讨眶爆裂骨折所致眶壁畸形、眼球陷没的影像学特征及对其外科治疗的价值。【方法】应用三维CT影像学技术及计算机三维诊断系统,观察11例眶壁畸形特征,测量眶腔容积变化。采用还纳眶内容、植骨恢复眶腔容积的方法进行整复。【结果】CT图像显示本组11例均呈眶底壁和/或内侧壁爆裂缺损,眼球后缩内陷。眶腔容积的增大与眼球内陷程度密切相关(r=0.9113)。经还纳眶内容及眶腔植骨手术,其中10例患者眼球陷没、复视得以矫正,眶、眼睑外形恢复良好。仅1例复视未得到矫正。【结论】CT能对眶壁骨折的性质、程度进行定性定量诊断分析。解除眼外肌粘连、还纳眶内容及眶腔植骨,是矫治复视和眶畸形的较好方法。

Objective] To investigate the features of enophthalmos and deformities of orbital walls in patients with orbital blowout fractures and the methods of surgical therapy. The features of orbital deformities and the changes of orbital volume were analyzed and measured by means of three dimensional CT technique and 3 D diagnostic computer assisted system .The reconstructive operations were employed on these 11 cases with orbital blowout fractures to correct deformities and restore orbital volume by applying autogenous bone grafts or hydroxyapatite bone substitutes. The CT images showed that there were bone defects of medial and inferior orbital walls and enophthalmos in all cases. Close correlation between orbital volume and extent of enophthalmos was found(r= 0 911 3).Of these 11 cases,10 cases got satisfactory appearance of eyelids and orbit , of which the diplopia and enophthalmos were corrected . Only 1 case remained diplopia after surgical correction. [ Conclusion] The features and extents of orbital fractures can be diagnosed by CT imaging technique.The surgical therapy of correcting diplopia and enophthalmos includes releasing extraocular muscles , putting back entrapped orbital content , implanting autogenous grafts and hydroxyapatite substitutes to restore orbital volume.