眶底和眶内侧壁骨折后眶内软硬组织移位的相关性

目的:对眶底和眶内侧壁骨折范围面积的大小和眶内移位软组织体积之间关系进行相关性研究。方法:15例颧眶骨折伴有眶底、眶内侧壁骨折、眶内软组织移位的患者分别做MSCT扫描,利用Simplant软件测量眶底和眶内侧壁骨折范围面积的大小和眶内移位软组织体积,做统计学分析,并将骨折形态以STL格式文件存储。结果:平均眶底骨折范围面积的大小为(4.64±0.77)cm2,平均眶底移位软组织体积是(2.58±1.33)cm3,两者相关关系是y=1.18602x-2.929,R=0.683。平均眶内侧壁骨折范围面积的大小为(5.53±1.14)cm2,平均移位软组织体积是(2.59±1.05)cm3,两者相关关系是y=0.6894x-1.1342,R=0.7829。结论:眶底和眶内侧壁骨折范围面积大小与其相应移位软组织容积存在线性相关关系。     

眶底骨折的手术治疗

<正> 眶底骨折是颌面外伤骨折之一,既往教课书中没有专门的论述,国外文献报道不多,国内未见报道。我院曾遇8例眶底骨折患者,现报道如下。临床资料8例均为男性。年龄19～45岁,平均35.6岁。根据 Converse 眶底骨折分类:爆裂型骨折单纯性4例,非单纯性爆裂骨折拌邻近面部     

眶底骨折23例临床分析

眶底骨折是眼眶骨折最多的一种。眶底壁骨质薄弱 ,受外力打击易造成眶底骨折 ,眼内容物移位 ,往往出现较明显的眼并发症。因此对眶底骨折的早期及时治疗对眼部功能恢复有重要作用。本文通过对 1 992年 2月至 1 999年 2月收集的 2 3例眶底骨折治疗情况的临床总结和分析。提出早期诊断、治疗的体会 ,并比较手术入路的合理选择与骨移植的具体应用。1　临床资料1 .1　一般资料　2 3例眶底骨折中 ,男性 2 1例 ,女性 2例 ,年龄1 3～ 56岁 ,平均年龄 31 .2 3岁 ,病程长短不一。致伤原因 ,交通事故伤 1 4例 (占 60 .87% ) ,拳击伤 3例 ,球击伤 2例 ,…     

网状眶底修复钛板治疗眶底骨折

目的:观察网状眶底修复钛板用于治疗眶底骨折的效果。方法:本文通过对27例眶周骨折患者采用坚强内固定技术固定骨折,并用网状眶底修复钛板治疗不易固定的眶底骨折,对术后效果进行跟踪观察。结果:所有患者眼球内陷和神经症状都得到了纠正,疗效满意。结论:使用眶底修复钛板或眶内侧壁修复钛板能有效恢复眶腔骨质延续性,并可以节省手术时间,降低手术创伤,术后并发症少,是处理眶底复杂骨折的有效方法之一。     

面中部骨折伴发眶底骨折的临床分析

目的探讨面中部骨折伴发眶底骨折的诊治方法。方法对136例面中部骨折伴发眶底骨折患者的治疗进行回顾性研究。136例患者均采用切开复位内固定术进行治疗,其中49例行眶底手术治疗,21例有眶底骨缺损的患者采用自体骨、钛网或多孔高分子聚乙烯进行眶底重建。结果136例骨折患者的面部外形和功能显著恢复,术后未发生永久性严重并发症,仅2例出现切口局部感染,1例暂时失明,经及时治疗后痊愈。结论面中部骨折伴发眶底骨折的首选诊断方法是CT;治疗原则是恢复眶底的解剖形态和眶腔容积,还纳疝入上颌窦的眶内容物,植入修复材料重建眶底。     

钛网支架修复眶底缺损

目的：探讨经头皮冠状切口或睑结膜切口入路,应用钛网支架重建眶底缺损的临床疗效。方法根据CT扫描和三维成像诊断,对18例眶底缺损患者进行微型钛网内固定术重建眶底缺损,其中10例为眶底伴邻近颅面骨折,采用头皮发际内冠状切口;8例为陈旧性眶底骨折,采用睑结膜切口。结果18例患者的眼球内陷和部分合并颧骨骨折的状况得到纠正,切口均愈合良好,切口位置较隐秘或未遗留瘢痕,颜面畸形得到明显改善。术后随访3～24个月,钛网支架无1例松动或移位或者其他并发症,疗效满意。结论头皮冠状切口入路以及睑结膜入路都能为术者提供足够视野与操作空间,应用微型钛网内固定术可重建眶底缺损,防止复视,术后美观效果佳。     

应用自体耳甲软骨瓣重建眶底

目的研究自体耳甲软骨瓣应用于眶底重建,对眶底骨折引起的复视和眼球内陷的疗效。方法自2003年7月～2007年6月应用耳甲软骨瓣重建眶底共21例。本组患者术前均经轴位和冠状位眶部CT证实存在眶底骨折下陷,且部分眶内容物疝入上颌窦,患侧眼球突出度与健侧相差3mm以上。自患侧耳廓切取耳甲软骨瓣（保留两侧软骨膜）,经下眼睑下缘切口入路,用耳甲软骨瓣修补眶底骨质缺损。术后均随访3个月以上,观察复视和眼球内陷的治疗效果,以及供区耳廓有无畸形。结果本组21例患者术后复视消失者19例（90.5%）、明显改善者2例（9.5%）;双侧眼球突出度相差≤2mm共17例（81.0%）,2.1mm～3.0mm共3例（14.3%）,〉3mm共1例（4.7%）;无一例出现耳廓畸形和耳甲软骨瓣感染。结论对于眶底骨折伴有眶底下陷,眶内容物疝入上颌窦以及双侧眼球突度相差明显的患者,应用耳甲软骨瓣重建眶底,可显著改善复视和眼球内陷等眼功能障碍,且不会引起供区耳廓畸形。     

眶底骨折95例临床分析

眶底主要由上颌骨眶突即上颌突上壁构成，内侧与筛板相通，结构薄弱，当中部受到外力冲击时，易发生眶底骨折，本文对我科近年收治的95例眶底骨折进行了回顾分析。     

眶底骨折钛网修复13例临床分析

应用钛网对13例眶底骨折并缺损病例进行修复,经过半年～3年的跟踪观察,10例行X线及CT检查,结果显示,钛网未见移位,临床检查无排斥反应,眼球下陷,复视得到矫治,眶下神经损伤得到恢复,因此认为钛网适合于眶底缺损的修复。     

眶底缺损重建材料的研究进展

眼眶底板骨质菲薄,当眶内容物受到钝力作用使眶内压突然升高时易发生骨折。眶底骨折因其所在位置特殊,一旦骨折则无法复位,只能采用材料修补眶底。目前许多材料被用于重建眶底缺损,包括一直被大家认为是“金标准”的自体骨。但自体骨也有一定局限性．如来源少及额外的手术负担,越来越多的异体材料被开发并运用到临床。本文对目前常使用的眶底重建材料作一综述。     

Evaluation of computer-based area and volume measurement from coronal computed tomography scans in isolated blowout fractures of the orbital floor.

PURPOSE: In this retrospective study, we evaluated isolated blowout fractures of the orbital floor by region-of-interest measurements from coronal computed tomography (CT) scans and their relationship to ophthalmologic findings. PATIENTS AND METHODS: Fracture area and volume of displaced tissue of blowout fractures in 38 patients were measured from coronal CT scans. Measurement was performed by identifying distances (for area calculation) of the fracture and identifying areas (for volume calculation) of the displaced tissue in each CT slice. The calculated data were then compared with the amount of enophthalmos, presence of diplopia, and limitation of ocular motility. RESULTS: Orbital floor area (mean +/- SD) was 5.72 +/- 1.07 cm(2); fracture area, 2.63 +/- 1.20 cm(2); and the volume of displaced tissue, 1.15 +/- 0.91 mL. The average proportion of the fracture within the orbital floor was 45.3 +/- 17.6%. Fracture area and volume of displaced tissue were significantly positively correlated with enophthalmos and diplopia and not correlated with the limitation of ocular motility. For enophthalmos of 2 mm or greater, mean fracture area (mean +/- SD) was 4.08 +/- 1.09 cm(2) and volume of displaced tissue was 1.89 +/- 1.19 mL; for less than 2-mm enophthalmos, 1.98 +/- 0.83 cm(2) and 0.83 +/- 0.58 mL, respectively. Enophthalmos of 2 mm can be expected with 3.38 cm(2) of fracture area and 1.62 mL of displaced tissue. CONCLUSIONS: Region-of-interest measurement from coronal CT scan has an application in the assessment of patients with pure blowout fractures of the orbital floor and adds useful information in posttraumatic evaluation of orbital fractures.     

Isolierte Orbitabodenfrakturen

Background

The goal of this retrospective study was quantitative calculation of area and volume of isolated orbital floor fractures from computed tomography (CT) and correlation of these data with post-traumatic ophthalmologic findings.

Patients and methods

A total of 76 patients with isolated orbital floor fractures were evaluated radiologically and clinically. CT scanning was performed in coronal sections (1.5-mm to 3.0-mm slice thickness) with contiguous table feed. Orbital floor and fracture area as well as volume of displaced tissue were measured and calculated from the CT dataset. The relation of quantitative CT data to ophthalmologic findings (motility, diplopia, and globe position) was assessed statistically.

Results

Calculation of the CT dataset revealed a mean orbital floor area of 6.33±1.05 cm², a mean fracture area of 2.60±1.14 cm², and a mean volume of displaced tissue of 1.16±0.80 cm³. Volume of displaced tissue correlated significantly with ophthalmologic findings (p≤0.01). Fracture area correlated significantly with globe position (p≤0.01) and was less associated with diplopia and motility disturbances (p<0.10).

Conclusion

Efficient evaluation of two-dimensional CT data enables quantitative assessment of orbital floor fractures. Position and function of the globe are mainly affected by the volume of displaced periorbital tissue.     

A computer-based method for calculation of orbital floor fractures from coronal computed tomography scans

PURPOSE: A computer program recently developed for the calculation of the orbital floor and fracture areas from coronal computed tomography (CT) scans was used in a study to evaluate the accuracy and ability of this new method. MATERIAL AND METHODS: The size of orbital floors and fabricated fractures in 14 dried, anatomic specimens were measured in coronal CT scans by 3 independent observers. Based on this data set, the orbital floor and fracture regions were calculated with the newly developed computer program. These calculated regions were then compared with a direct measurement of the specimens that had been obtained by digital photography. The accuracy of the computer-based calculations was assessed using Lin's concordance correlation coefficient. RESULTS: The size of the orbital floor (mean +/- SD) was found to be 5.21 +/- 0.39 cm(2) by direct measurement of the specimens and 5.30 +/- 0.52 cm(2) by calculation with the computer program. The region of the fracture (mean +/- SD) was 1.05 +/- 0.64 cm(2) by direct measurement and 1.01 +/- 0.62 cm(2) by computer calculation. The between-method mean difference (direct measurement minus computer based calculation) was -0.09 cm(2) (or 1.7% of mean orbital floor region) for orbital floor region and 0.04 cm(2) (or 3.8% of mean fracture region) for fracture region. CONCLUSIONS: This accurate and time-saving method is practicable for determining the size and location of orbital floor fractures. This calculation program can be advantageously applied in the clinical management of blowout fractures of the orbit.     

Forces charging the orbital floor after orbital trauma

The objectives of this study were (i) to evaluate different fracture mechanisms for orbital floor fractures and (ii) to measure forces and displacement of intraorbital tissue after orbital traumata to predict the necessity of strength for reconstruction materials. Six fresh frozen human heads were used, and orbital floor defects in the right and left orbit were created by a direct impact of 3.0 J onto the globe and infraorbital rim, respectively. Orbital floor defect sizes and displacement were evaluated after a Le Fort I osteotomy. In addition, after reposition of the intraorbital tissue, forces and displacement were measured. The orbital floor defect sizes were 208.3 (SD, 33.4) mm(2) for globe impact and 221.8 (SD, 53.1) mm(2) for infraorbital impact. The intraorbital tissue displacement after the impact and before reposition was 5.6 (SD, 1.0) mm for globe impact and 2.8 (SD, 0.7) mm for infraorbital impact. After reposition, the displacement was 0.8 (SD, 0.5) mm and 1.1 (SD, 0.7) mm, respectively. The measured applied forces were 0.061 (SD, 0.014) N for globe impact and 0.066 (SD, 0.022) N for infraorbital impact. Different fracture-inductive mechanisms are not reflected by the pattern of the fracture. The forces needed after reposition are minimal (~0.07 N), which may explain the success of PDS foils [poly-(p-dioxanone)] and collagen membranes as reconstruction materials.     

Follow-up study of treatment of orbital floor fractures: relation of clinical data and software-based CT-analysis

This retrospective study quantifies isolated orbital floor fractures using software-based CT-analysis and compares the clinical outcome across surgical and non-surgical treatment groups. Depending on the surgeon's interpretation of the clinical and radiological appearance, 10 fractures were treated non-surgically and 20 fractures surgically, either with antral balloon catheter alone or in combination with an orbital implant. Ophthalmologic findings were evaluated until 12 weeks after injury. Fracture area, and volume of displaced tissue (VDT) were assessed by software-based CT-analysis. VDT was marginally significantly smaller in non-surgically than in surgically-treated patients (P=0.08). Ophthalmologic findings improved in all groups during follow-up and no statistical difference was found between the groups. Diplopia remained moderate in three patients with balloon catheter alone, and minimal in four patients in both surgical groups. In one patient with non-surgical treatment, diplopia remained minimal after 12 weeks. Although CT-analysis revealed no significant difference between both surgical groups, patients treated with balloon catheter alone presented more diplopia after 12 weeks. Using balloon catheters for fracture repair a combined approach should be performed when large fractures involve the orbital floor to achieve sufficient reduction of orbital content and placement of an orbital implant. Software-based CT-analysis is helpful for objective interpretation in managing of orbital fractures.     

Non-displaced pediatric orbital fracture with displacement of the inferior rectus muscle into the maxillary sinus: a case report and review of the literature

Orbital fractures occur less frequently in the pediatric population than in the adult population. Due to the elasticity of the bones that comprise the orbital floor it is not uncommon for the orbital floor to fracture and immediately self-reduce. This puts the muscles and soft tissues of the orbital floor at an increased risk of entrapment. There is no exact agreement in the literature as to the ideal timing of surgical intervention for these types of injuries. However, there are many surgeons who advise early intervention in the first few days of the injury. This article describes a case of a non-displaced orbital fracture with displacement of the inferior rectus into the maxillary sinus that was treated in the first 24 h and resulted in an excellent outcome.     

2D- and 3D-based measurements of orbital floor fractures from CT scans.

OBJECTIVE: Two methods for area and volume calculation of the orbit were evaluated following blow-out fractures of the orbital floor using computed tomography (CT) scans. MATERIAL AND METHODS: Isolated blow-out fractures of the orbital floor in human cadavers were simulated by fracturing the orbital floor and placing a defined volume of silicone within each defect. The area of fracture and the volume of silicone simulating herniated periorbital tissue were evaluated in 16 orbits by the use of a three-dimensional (3D) CT-based software package (Analyze((R)); Mayo Clinic, Rochester, MN, USA) and software based on two-dimensional (2D) coronal CT scans. Both methods were compared with direct anatomical measurements and evaluated with Lin's concordance coefficient (rho(c)). RESULTS: Between-method concordance of area and volume calculation were rho(c)=0.962, and 0.872 for the 3D-CT-based method, and 0.981 and 0.952 for the 2D-CT method, respectively. The time allocated for measurement was significantly longer for the 3D-CT than for the 2D-CT method (p<0.001). CONCLUSION: Calculations of blow-out fractures of the orbital floor by 3D-CT and 2D-CT method are accurate for assessing the area of fracture and the volume of herniated tissue. Lesser processing time and simple usage favour the 2D-CT-based calculation method.     

Maximum forces applied to the orbital floor after fractures

ABSTRACT: The objective of this study was to measure the force on and displacement of completely detached intraorbital tissue from thebony orbit, as a worst-case scenario after orbital trauma, to preserve the maximum load and predict the necessary strength of reconstruction materials. Six fresh-frozen human heads were used, and orbital floor defects in the right and left orbits were created by the direct impact of 3.0 J onto the globe and infraorbital rim. The orbital floor defect sizes and displacements were evaluated after performing a Le Fort I osteotomy. In addition, after the repositioning of the completely detached intraorbital tissue, the forces and displacements were measured. The mean orbital floor defect sizes were 208.3 (SD, 33.4) mm for globe impacts and 221.8 (SD, 53.1) mm for infraorbital impacts. The mean intraorbital tissue displacement after the impact and before repositioning was 5.6 (SD, 1.0) mm for globe impacts and 2.8 (SD, 0.7) mm for infraorbital impacts. After repositioning, the displacements were 0.8 (SD, 0.5) mm and 1.1 (SD, 0.7) mm, respectively. The measured forces were 0.10519 (SD, 0.00958) N without the incorporation and approximately 0.11128 (SD, 0.003599) N with the incorporation of reconstruction materials. The maximum forces on the completely detached orbital tissue were minimal (～0.11 N) and suggest the use of collagen membranes as reconstruction materials for orbital floor defects, at least in medium-sized fractures.     

Effectiveness of a nasoseptal cartilaginous graft for repairing traumatic fractures of the inferior orbital wall

The goals of reconstruction after an orbital fracture are to restore the continuity of the floor, provide support for the orbital contents, and prevent fibrosis of the soft tissues. Nasoseptal cartilage is an easily accessible, abundant, and autogenous source that supports the orbital floor and gives minimal donor site morbidity. We evaluated the effectiveness of nasoseptal cartilage for repairing traumatic defects of the orbital floor. Autogenous nasoseptal cartilage was used in 20 patients. Presence or absence of diplopia, enophthalmos, paraesthesia of the infraorbital nerve, dystopia, range of covering of the defect by nasoseptal cartilage, complications at the recipient and donor sites, resorption of the graft, and ocular mobility disorders were recorded. Entrapment of orbital tissues, a large orbital defect (more than 50% of orbital floor or more than 8mm), or defects of the orbital floor with involvement of other fractures of the zygomaticofrontal complex are indications for exploration of the orbit. In one case after 24 months, the surgical field was explored for direct evaluation of the efficacy of the graft. All patients were treated successfully by restoration of the continuity of the orbital floor. Six months to 2 years follow up showed only one patient with postoperative enophthalmos. There was no donor site morbidity, and no grafts became infected or extruded. The nasoseptal graft was completely covered with underlying tissue. Nasoseptal cartilage is readily accessible autogenous tissue that should be considered when an autogenous graft is needed for reconstruction of a defect of the orbital floor.