爆裂性眶壁骨折修复手术的效果评价  

Evaluation of the effect of repair surgery for burst wall fracture

作　　者：王珏 王为农 张婕 WANG Jue;WANG Wei-nong;ZHANG Jie(Department of Ophthalmology,Tangdu Hospital,Air Force Military Medical University,Xi'an Shaanxi 710038,China)

机构地区：[1]空军军医大学唐都医院眼科

出　　处：《临床和实验医学杂志》2020年第1期48-51,共4页Journal of Clinical and Experimental Medicine

基　　金：国家自然科学基金青年项目(编号:81300743)

摘　　要：目的评价爆裂性眶壁骨折修复术对消除复视、改善眼位及眼球凸出度的效果。方法回顾性总结2015年1月至2019年1月间空军军医大学唐都医院因爆裂性眶壁骨折而行手术治疗的病例共65例(65眼),其中下壁骨折及内、下壁联合骨折患者选取下睑缘皮肤切口,内壁骨折选取内眦部结膜切口,植入Medpor外科植入体修复骨折缺损处。对比术前术后眼眶CT检查结果;比较术前术后患者复视、眼球内陷及眼球凸出度的改善情况评价手术效果。结果65例患者中,45例复视患者经手术修复后,其中28例患者复视完全消失,16例患者复视得到明显改善,1例患者复视无明显改善;50例眼球内陷患者中,30例患者眼球内陷完全矫正(凸出度差值≤2 mm);14例患者眼球内陷部分改善(凸出度差值2~4 mm);6例患者眼球内陷改善欠佳(凸出度差值>4 mm),但该6例患者的初始凸出度差值均>5 mm,且手术时机均为>伤后4周。所有患者均未出现视力下降或丧失、植入物排异现象、感染、眼部畸形等并发症。结论爆裂性眶壁骨折修复手术能有效地改善患者复视及眼球内陷症状,该手术安全,创伤小,不遗留瘢痕,Medpor植入材料排异现象少,术后可重建眶壁骨折处的骨壁形态。Objective To evaluate the effect of repair surgery for burst wall fracture on eliminating double vision,improving eye position and ocular protrusion.Methods A total of 65 patients(65 eyes)who underwent surgical treatment for burst wall fractures from Jan 2015 to Jan2019 were included.The middle and lower wall fractures patients and internal and inferior wall fractures patients were treated with inferior temporal margin skin incision,while the internal wall fracture patients were selected from the inferior temporal conjunctival incision.The Medpor surgical implant was implanted to repair the fracture defect.The evaluation of surgical effect depended on the comparison of the CT scan of eyelid before and after operation,and the restore results of the preoperative and postoperative patients with diplopia,eye position and ocular protrusion were also important indexes of the evaluation of surgical effect.Results In the 65 patients,45 patients with diplopia were surgically repaired,including 28 patients with complete disappearance of diplopia,16 patients with significant improvement in diplopia,and 1 patient with no significant improvement in diplopia;among the 50 patients with retinal invagination,30 patients had complete correction of eyeball retraction(convex difference≤2 mm),14 patients had improved eyeball invagination(convex difference 2~4 mm),6 patients had poor eyeball retraction(convex difference>4 mm),which might due to the initial bulge difference of the 6 patients>5 mm,and the timing of the operation was>4 weeks after the injury.All patients had no complications such as decreased vision or loss of vision,rejection of the implant,infection,or ocular deformity.Conclusion The repair of burst wall fracture can effectively improve the patients’diplopia and eyeball invagination symptoms.The operation is safe,the trauma is small,no scar remains,and there was less rejection of Medpor implants,the shape of the bone wall at the fracture of the sacral wall can be reconstructed after operation.

关 键 词：爆裂性眶壁骨折 修复手术 复视 眼球凸出度 术后恢复 

分 类 号：R779.6[医药卫生—眼科]