眶壁修复和重建技术在眶骨骨折手术治疗中的应用  

Application of orbital wall repair and reconstruction technique in surgical treatment of orbital fracture

作　　者：曾敏[1] 张菊[1] 曾洁莲 郭金林[1] 肖莉 邱圣华 黄庭美 ZENG Min;ZHANG Ju;ZENG Jie-lian;GUO Jin-lin;XIAO Li;QIU Sheng-hua;HUANG Ting-mei(Department of Ophthalmology,Xinfeng People's Hospital,Xinfeng,Jiangxi 341600)

机构地区：[1]信丰县人民医院眼科,江西信丰341600

出　　处：《赣南医学院学报》2021年第11期1135-1137,共3页JOURNAL OF GANNAN MEDICAL UNIVERSITY

摘　　要：目的:探究眶壁修复和重建技术在眶骨骨折手术治疗中的应用。方法:选取本院2015年9月—2020年9月收治的眶底和眶内侧壁爆裂性骨折患者38例,术前进行常规检查(视力检查、眼位、眼球运动、瞳孔及对光反射、被动牵拉试验等)、眼眶CT检查和眼眶三维重建检查。全面了解眼眶各骨壁的骨折情况以及是否合并眶内软组织移位、嵌顿和眼球内陷。手术尽可能修复重建缺损部位,复位移位、嵌顿的软组织,确保重建稳固的眶底支撑和眶内侧壁屏障,防止其再次移位或疝出,让内陷的眼球回归到正常位置,恢复双眼单视功能。结果:38例患者中32例治疗后获得了良好效果,所有的嵌顿组织均已还纳复位,眼球内陷全部纠正,眼球运动恢复正常,眶壁均已修复、重建,患者复视症状消失,总有效率达84.2%。结论:有手术指征的眶底和眶内侧壁爆裂性眶骨骨折手术重点是修复、重建眶下壁和内侧壁,还纳复位嵌顿眶内组织,解除眼球机械限制,恢复双眼单视功能。作为手术者,要综合自己的技术水平和单位设备条件、患者具体情况和诉求,严格把握手术适应症,做好全面的术前检查,设计个体化的手术治疗方案,且对超过3周的患者慎重手术。Objective:To explore the application of orbital wall repair and reconstruction technology in the surgical treatment of orbital fracture.Methods:A total of 38 cases with orbital floor and medial orbital wall burst fractures admitted to our hospital from September 2015 to September 2020 were selected.Routine preoperative examination was done,including visual acuity,eye position,eye movement,pupil and light reflection,passive pull test,orbital CT examination and three-dimensional reconstruction examination.The fracture of orbital bone wall and whether it was associated with displacement of orbital soft tissue,incarceration state and enophthalmus were fully understood.The defect was repaired and reconstructed as much as possible,the displaced and incarcerated soft tissues were reduced,and the orbital floor support and the medial orbital wall barrier were ensured to be reconstructed to prevent the re-displacement or herniation,so that the invasions of the eyeball could return to the normal position and the function of binocular monocular vision could be restored.Results:In 32 of 38 cases,good results were obtained.All incarcerated tissues were restored,the eyeball invagination was corrected,the eye movement was restored to normal,the orbital wall was repaired and rebuilt,and the diplopia disappeared.The total effective rate was 84.2%.Conclusion:The key points of the operation for the burst orbital fracture of the orbital floor and medial wall with surgical pointer are to repair and reconstruct the inferior and medial orbital wall,reduce the incarcerated orbital tissues,remove the mechanical restriction of the eyeball and restore the binocular monopyopia.As surgeons,they should consider their own technical level,equipment conditions,patients'specific conditions and demands,strictly grasp the indications of surgery,do a comprehensive preoperative examination and preoperative evaluation,design individual surgical treatment plans.and be cautious about surgery for cases more than 3 weeks of onset.

关 键 词：眶壁修复 眶壁重建 眶骨骨折 

分 类 号：R779.[医药卫生—眼科]