眼眶爆裂性骨折的早期和晚期整复手术疗效比较

A comparison of early and late reconstruction and repositioning of orbital blow-out fracture

目的 研究眼眶爆裂性骨折早期和晚期整复手术疗效的差异。方法 应用眼眶三维重建 ,CT扫描和复视分析方法 ,以Medpor为填充材料 ,对 15例早期和 16例晚期爆裂性骨折实施眼眶重建术 ,并进行术后疗效比较性研究。结果 早期手术患者中复视 8例 ,术后复视未消失 1例。眼眶内陷 15例均得到矫正 ,内陷均小于 2mm。眶下神经感觉减退 10例 ,术后眶下神经感觉减退 2例。晚期手术患者中术前复视 10例 ,术后未消失 7例 ,其中未改善 4例 ,加重 2例 ,5例行眼外肌手术矫正复视得到一定改善。眼眶内陷 16例中术后未矫正 3例 ,内陷大于 2mm ,再次手术 2例。眶下神经感觉减退 9例 ,术后未改善 2例。经Fisher精确率检验两组患者术前和术后疗效比较中 ,只有复视矫正的差异有显著性 (χ2 =4 86 5 ,P <0 0 5 )。结论 手术是治疗眼眶爆裂性骨折较好的方法 ,早期手术比晚期手术操作容易、效果好、恢复快、并发症少、再次手术机会少。

Objective To study and compare the operative results of the early and late treatment of orbital blow-out fracture. Methods Orbital blow-out fractures were reconstructed and repositioned. Three dimensional measurements, CT scanning, diplopia analysis, Medpor filling of the orbit were used for the operation and the study. The operative results were compared between 15 cases of early and 16 cases of late reconstruction of blow-out fracture. Results In the early treatment group, there were 8 cases of diplopia, 15 cases of orbital invagination and 10 cases of disesthesia of the infraorbital nerve. After surgery, diplopia was corrected in 7 cases; invagination was corrected in all the 15 cases; disesthesia of the infraorbital nerve was corrected in 8 cases. In the late treatment group, there were 10 cases of diplopia, 16 cases of orbital invagination and 9 cases of disesthesia of the infraorbital nerve. After surgery, diplopia was corrected in 3 cases, unimproved in 4 cases, aggravated in 2 cases. 5 of them received reoperation of extraocular muscle for diplopia. Orbital invagination was uncorrected in 3 cases. 2 of them were re-operated on. Disesthesia of the infraorbital nerve was unimproved in 2 cases. By comparing the operation results of the two groups using FISHER accuracy inspection, the significant difference was only in the correction of the double visions (χ 2=4.865,P<0.05). Conclusion Early operation for orbital blow-out fracture is easier, with better results, fewer complications and reoperations than the late operation.;