爆裂性眶内壁骨折术后并发症的临床观察  

Clinical Observation on the Postoperative Complications of the Blowout Fracture of Medial Orbital Wall

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

机构地区：[1]河北医科大学第三医院眼外伤科,河北石家庄

出　　处：《眼科学》2019年第1期52-56,共5页Hans Journal of Ophthalmology

摘　　要：目的:观察研究爆裂性眶内壁骨折术后并发症的原因及对应处理。方法:对我科2013年1月1日至2018年12月31日收治的爆裂性眶内壁骨折术后出现并发症的患者进行回顾性分析。结果:在此期间,我科共收治43例有手术指证的爆裂性眶内壁骨折患者,其中有14例存在不同程度的术后并发症:2例(4.7%)于术后3天内出现明显的视力下降,并伴视野缺损。其中1例入院时患眼视力0.4,矫正0.8。术后患者自述患眼视物模糊,伴眼前黑影,患眼视力0.2,矫正0.6,给予营养神经及激素治疗,术后1个月恢复至0.3,矫正1.0;另1例视力下降患者入院时患眼视力0.6,术后视力下降至0.2,给予相应治疗后出院时视力恢复正常。2例(4.7%)于术后2周仍存在明显复视,9例(20.9%)仍存在极周边复视,2例(4.7%)于术后1个月仍存在明显复视,4例(9.3%)存在极周边复视。在对术后复视患者进行随访过程中,2例(4.7%)术后3个月仍存在复视,眼球内陷欠矫正 >1 mm,2例(4.7%)存在极周边复视残留。1例(2.3%)术后1年发现慢性泪囊炎。结论:爆裂性眶内壁骨折术后可出现多种并发症,在处理眶壁骨折的临床工作中,要注重结合眼眶解剖特点、人工材料的位置、术前专科检查明确骨折部位、选择恰当的手术时机及手术方案,术中需操作轻柔精细,注重术后检查、护理及治疗,提高手术质量。Objective:To explore the reason and the corresponding measures about the postoperative com-plications of the blowout fracture of medial orbital wall.Method:A retrospective review was made on the postoperative complications of the patients with the blowout fracture of medial orbital wall in our department from January 1,2013 to December 31,2018.Results:Within the period,43 cases of the blowout fracture of medial orbital wall under the surgical indications were treated in our department,14 of which were found different degrees of postoperative complications.Two cases(4.7%)had significant visual decrease and visual field defect within 3 days after surgical operations.One of the two patients had visual acuity of 0.4 and corrected 0.8 at admission.After the operation,the person reported a blurred vision with dark shadow in front of eyes,visual acuity 0.2,corrected 0.6.Given the nutritional nerve and hormone treatment,his visual acuity recovered to 0.3,corrected 1.0 in one month.The visual acuity of the other one decreased from 0.6 to 0.2 after operation and recovered to normal by corresponding measures.Two cases(4.7%)still had significant diplopia 2 weeks after the operation.9 cases(20.9%)had extreme peripheral diplopia.One month after the operation,2 cases(4.7%)still had obvious diplopia,and the number of the person that had extreme peripheral diplopia declined to 4(9.3%).During the follow-up of patients with diplopia after the surgical operation,2 cases(4.7%)still had diplopia 3 months after operation.The undercorrection of enophthalmos was more than 1 mm,and 2 cases(4.7%)had the residual of extremely peripheral diplopia.One year after the treatment,1 case(2.3%)was diagnosed as chronic dacryocystitis.Conclusion:There are several postoperative complications on blowout fracture of medial orbital wall.During the clinical work of orbital wall fracture,the surgeon ought to not only pay close attention to considering the anatomical characteristics of the orbit,the location of artificial materials,but also define the locat

关 键 词：爆裂性眶内壁骨折 术后并发症 复视 眼球内陷 视力下降 视野缺损 慢性泪囊炎 

分 类 号：R77[医药卫生—眼科]