眶-上颌-颧骨骨折手术治疗情况分析  

Analysis of surgical treatment of orbital maxilpry zygona fracture

作　　者：曹蕾 静如意 周润海 韩文峰 刘斌 CAO Lei;JING Ru-yi;ZHOU Run-hai;HAN Wen-feng;LIU Bin(Department of Ophthalmology,General Hospital of Northern Theater Command,Shenyang 110016,China;Department of Orthopedics,General Hospital of Northern Theater Command,Shenyang 110016,China)

机构地区：[1]北部战区总医院眼科,辽宁沈阳110016 [2]北部战区总医院骨科,辽宁沈阳110016

出　　处：《临床军医杂志》2023年第1期32-35,共4页Clinical Journal of Medical Officers

基　　金：解放军总后勤部卫生部科研基金(CLB20J040)。

摘　　要：目的 分析眶-上颌-颧骨(OMZ)骨折手术治疗的情况。方法 回顾性分析北部战区总医院自2017年6月至2019年6月收治的接受眶壁骨折修复术联合颧骨上颌切开复位内固定术的40例(40眼)OMZ骨折患者的临床资料。记录患者的一般资料。术后随访6个月,比较术前术后的Logmar视力和眼球运动分级,观察复视治疗效果和并发症发生情况。结果 40例患者中,男性32例(32眼),女性8例(8眼);平均年龄(39.54±15.91)岁;左眼24例,右眼16例;口外联合眶下壁10例,联合内下壁13例,联合内下外侧壁17例;均有明确外伤史,交通事故23例,摔伤12例,攻击5例;合并颅脑外伤16例,合并下肢骨折9例,清创缝合14例。患者术前Logmar视力为0.35(0.10,0.55),术后为0.10(0,0.50),术后视力优于术前,差异有统计学意义(P<0.05)。术前眼球运动分级0级8例,Ⅰ级31例,Ⅱ级0例,Ⅲ级1例;术后6个月时眼球运动分级0级27例,Ⅰ级12例,Ⅱ级0例,Ⅲ级1例。术前复视的20例患者,术后治愈11例,好转5例,无效4例。术前外伤所致并发症包括2例泪小管断裂和2例上睑下垂。2例泪小管断裂患者于伤后3个月接受泪道支架植入术,恢复良好,溢泪明显改善;2例上睑下垂患者术后上睑下垂由术前的遮挡瞳孔全部到术后6个月的遮挡瞳孔1/3。术后并发症包括面部麻木4例、上睑沟加深2例及眼球内陷需要手术矫正2例。4例面部麻木患者接受甲钴胺片口服3个月、麻木面部皮肤热敷、针灸等治疗,其中,2例自觉好转,2例自述无明显改善,原因可能为患者接受手术时间分别为伤后17 d、12 d,眶下神经损伤时间较长且眶下壁骨折较重;2例上睑沟加深患者对眼周美观要求不高,未接受治疗;2例眼球内陷需要手术矫正患者于术后1年接受楔形体植入术,恢复良好。结论 交通事故是OMZ骨折的首要致伤原因,眶壁骨折修复术联合颧骨上颌切开复位内固定术治疗OMZ骨折的临床效果良好,可减Objective To analyse surgical treatment of orbital maxilpry zygona(OMZ)fracture.Methods The clinical data of 40 patients(40 eyes)with OMZ fracture who received orbital fracture repair combined with oral surgery and internal fixation through zygomaticomaxillary incision from June 2017 to June 2019 in General Hospital of Northern Theater Command were retrospectively analyzed.General patient information was recorded.The Logmar visual acuity and eye movement grade were compared before and after the operation, and the treatment effect and complications of diplopia were observed.Results Among the 40 patients, there were 32 males(32 eyes)and 8 females(8 eyes).The mean age was(39.54±15.91)years.Left eye 24 cases, right eye 16 cases.Extraoral combined with the inferior orbital wall in 10 cases, the inferior medial wall in 13 cases, and the inferior medial lateral wall in 17 cases.There were 23 cases of traffic accident, 12 cases of fall injury and 5 cases of assault.16 cases were complicated with craniocerebral trauma, 9 with lower limb fracture, 14 with debridement and suture.Logmar visual acuity was 0.35(0.10,0.55)before surgery and 0.10(0,0.50)after surgery.Postoperative visual acuity was better than that before surgery, and the difference was statistically significant(P<0.05).Preoperative eye movement classification was grade 0 in 8 cases, grade Ⅰ in 31 cases, grade Ⅱ in 0 cases and grade Ⅲ in 1 case.Six months after surgery, 27 cases had grade 0,12 cases had grade Ⅰ,0 cases had grade Ⅱ,and 1 case had grade Ⅲ.Of the 20 patients with diplopia before surgery, 11 were cured, 5 were improved and 4 were ineffective.The complications of preoperative trauma included 2 cases of lacrimal duct rupture and 2 cases of ptosis.Two patients with lacrimal canalicle rupture received lacrimal duct stent implantation 3 months after the injury, and the recovery was good, and the tear overflow was obviously improved.The occluded pupils of 2 patients with ptosis after operation changed from all the occluded pupils before opera

关 键 词：眶-上颌-颧骨骨折 复视 眼球运动 眼眶复合性骨折 

分 类 号：R779.6[医药卫生—眼科] R782.4[医药卫生—临床医学]