鼻眶筛骨骨折后内眦畸形的晚期整复及其疗效  

Late management of medial canthal deformities after naso-orbital-ethmoid fractures

作　　者：范先群[1] 傅瑶[1] 李瑾[1] 周慧芳[1] 刘海燕[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院眼科,200011

出　　处：《中华眼科杂志》2006年第7期611-615,共5页Chinese Journal of Ophthalmology

基　　金：上海市卫生系统百名跨世纪优秀学科带头人培养计划基金资助项目(98BR005);上海市青年科技启明星后计划基金资助项目(00QMH1406)

摘　　要：目的探讨鼻眶筛骨骨折后内眦畸形的手术方法及其疗效。方法回顾性分析1999年1月至2004年1月上海交通大学医学院附属第九人民医院眼科诊治的83例(83只眼)单侧鼻眶筛骨骨折后内眦畸形患者行内眦韧带固定和畸形矫正术的临床资料和随访结果。依据内眦移位眼睑畸形的不同和皮肤的瘢痕情况,而分别选择“Y-V”成形、“Z”改形、“Mustard”法及旋转皮瓣矫正内眦皮肤和软组织异常;根据鼻眶筛骨骨折后“中心骨段”骨折或移位的情况,选择缝合固定、钛钉固定、钻孔固定及中心骨段复位钛板固定方法行内眦韧带固定术;对伴有泪道阻塞患者,泪道手术与内眦畸形矫正术同期进行;对伴有眼球移位或鼻梁塌陷患者,先行眼眶重建和隆鼻术,二期行内眦整复手术。83例患者术后随访12-30个月。结果72例患者术后内眦点水平和垂直位置与健侧基本对称,水平和垂直向移位均≤1 mm,内眦凹陷恢复,外观满意。但是11例患者术后6个月内出现内眦移位的复发,其中6例患者再次施行内眦韧带固定和内眦成形手术,术后畸形改善,再无复发移位。结论根据鼻眶筛骨骨折情况和内眦移位严重程度,选择不同的内眦韧带固定方法和内眦成形术,矫正内眦畸形效果显著,疗效稳定。Objective To evaluate the surgery methods and effectiveness of medial canthal deformities after naso-orbital-ethmoid fractures （ NOE ） and analysis the long-term results. Methods The clinical data and following-up results from 83 patients （83 eyes）, which were treated in the Department of Ophthalmology, Ninth People＇s Hospital, Medical School of Shanghai Jiao Tong University from January 1999 to January 2004, were retrospectively analyzed. All the patients had unilateral medial canthal deormities after NOE fractures, and they were on operations of medial canthoplasty and fixation of the canthal ligament. Based on the severity of the canthal deformities and local scar of the area, different skin flaps were utilized for canthoplasty, such as ＂Y-V＂ flap, ＂Z＂ flap, ＂Mustard＂ method and rotation flaps. According to the fracture pattern and severity of the medial canthal tendon＇s injury, different medial canthopexy were performed such as suturation, fixation with titanium nail, drilling a role across the bone, and repesition the ＂central segment＂ using titanium miniplates. The surgery to repair the obstruction of the lacrimal system were accompanied with canthoplasty at the same time, while the orbital surgery for repesiton of the enophthalmos was often performed at the first stage, and then the deformities of medial canthus were corrected after more than six months. The follow-up time varied from 12 to 30 months. Results 72 cases obtained satisfied contour of the medial canthal area, the position of the canthus was symmetry with the normal side, especially the formation of the canthal fossa. Recurrence of deformities occurred in 11 cases in six months after canthoplasty, among them 6 patients were re-operated for the second time. Conclusion According to the fracture pettern and severity of the medial canthal deformity, different operative designs and canthoplasy can produce satisfied results.

关 键 词：筛骨 骨折 骨折固定术 修复外科手术 

分 类 号：R779.6[医药卫生—眼科]