眶下壁骨折不同入路修复手术的效果比较  

Comparison of the different approaches of reconstruction surgery for orbital floor fracture

作　　者：江新利[1] 苗慧鹏[1] 周忠友[1] 张晓融[1] 刘金玲[1] 

机构地区：[1]河北医科大学第三医院眼科,石家庄050051

出　　处：《中华眼外伤职业眼病杂志》2016年第5期340-343,共4页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的对比两种不同手术入路修复眼眶下壁爆裂性骨折的效果。方法回顾性分析单纯眶下壁爆裂性骨折107例（107眼）的治疗情况。其中47例采用鼻内窥镜上颌窦入路，60例采用下睑缘皮肤切口入路，均以羟基磷灰石复合骨片修复缺损区。结果两组术后复视和眼球运动障碍症状较术前均有改善。鼻内窥镜上颌窦入路组复视和眼球运动障碍恢复时间为分别为（7．00±2．92）d和（6．72±2．66）d，短于下睑缘皮肤切口组的（9．26±4．89）d（t=～2．804，P=0．006）和（9．07±3．84）d（t=-2．981，P=0．004）。术后眼球突出度较术前均有不同程度的提高。鼻内窥镜上颌窦入路组术后眼球突出度提高（1．13±0．68）mm，经下睑缘下皮肤切口组术后眼球突出度提高（2．61±0．90）mm，两组间差异有统计学意义（t=-9．927，P=0．000）。下睑缘切口组8例出现明显的切口瘢痕，其中5例出现下睑收缩巩膜外露。结论两种方式的眼眶下壁爆裂性骨折羟基磷灰石复合骨片修复术均可有效矫正复视和眼球运动障碍，但各有其优缺点。鼻内窥镜上颌窦入路具有创伤小、恢复快的优点，而下睑缘切口入路在矫正眼球内陷方面优于鼻内窥镜上颌窦入路。Objective To compare the effect of two different surgical approaches for orbital floor blowout fracture reconstruction. Methods The surgical outcomes of 107 eyes of 107 patients with orbital floor fractures were retrospectively reviewed. Forty-seven eyes were treated through endoscopic transmaxillary approach surgery and 60 eyes through lower lid approach. Hydroxyapatite was used for fracture reconstruction. Results Both of the two groups showed significant clinical improvement in diplopia and limited extraocular motion. The recovery time of postoperative diplopia and limited extraocular motion in endoscopic transmaxillary group was （7.00± 2.92） d and （6.72 ± 2.66 ） d respectively, which were shorter than that of （9.26±4.89） d （ t = - 2. 804, P = 0. 006） and （9.07±3.84） d （ t = - 2. 981, P = 0.004 ） in lower lid group. Enophthalmos was improved in both groups. The degree of postoperative enophthalmos increased （1.13 ±0.68） mm in endoscopic transmaxillary group. Compared with （2.61 ±0.90） mm in lower lid group, there was statistically significant difference between the two groups （ t = - 9. 927, P = 0.000）. In lower lid group, significant eyelid scar was observed in 8 cases, and slight lower lid retraction was observed in 5 cases. Conclusion Surgical reconstruction with hydroxyapatite implantation for orbital floor blowout fracture via the two methods could effectively improve the diplopia and limited extraocular motion. Both of them have advantages and disadvantages. The endoscopic transmaxillary approach has the advantages of small damage and quick recovery, while the lower lid approach is better in significant enophthalmos correcting.

关 键 词：眶骨折 爆裂性 眶下壁 修复手术 上颌窦入路 鼻内窥镜 下睑缘入路 效果比较 

分 类 号：R779.6[医药卫生—眼科]