眶周骨折伴复视的CT评价

目的 :探讨外伤性眶周骨折伴复视的CT诊断价值。方法 :回顾性对照分析 68例 ( 70只眼 )眶周骨折伴复视病例的CT图象和专科检查、临床资料 ,进行定位诊断和骨折分型。结果 :70只眼中眶底爆裂性骨折 45只眼 (其中 15只眼合并眶内侧壁骨折 ) ,眶底非爆裂性骨折 10只眼 ,鼻眶骨折 5只眼 ,颧骨骨折 5只眼 ,眶上部骨折 5只眼。CT检查诊断眶周骨折的正确率可达 10 0 %。 68例中 64例临床出现垂直复视 ,4例为水平复视。结论 :CT可以正确诊断眶周骨折部位并分型 ,帮助鉴别产生复视的原因 ,为临床提供科学依据     

计算机导航在单侧眼眶骨折眶壁重建中的应用评价

目的 评价导航系统在单侧眼眶骨折眶壁重建中的应用效果.方法 在导航指导下完成眶壁重建的15例单侧眼眶骨折患者纳入研究,其中,男性7例,女性8例,平均年龄(34.3±9.5)岁.术前CT扫描、数据导入BrainLab导航系统工作站、以健侧眼眶CT数据的镜像作为参考,完成术前设计.对粉碎性严重眶壁骨折则以镜像数据为基础,制作模板并在模板上完成钛网预成形;如眶壁骨折较局限,则采用羟基磷灰石补片在术中直接完成眶壁缺损修复.在导航系统的指导下分别以钛网(10例)、羟基磷灰石补片(5例)完成眶壁重建.术后再次CT扫描,评价导航系统应用效果4个变量:①整体眶腔容积差;②眶壁疝出组织体积;③眼球内陷程度;④重建误差.由于羟基磷灰石在CT中显像效果差,因此,只测量钛网移植病例的重建误差.结果 所有病例均未出现视神经损伤、感染或植入体排斥等并发症.经测量术前平均眼球内陷(3.5±1.6) mm、整体眼眶容积差(4.5±1.8) ml、疝出组织体积(2.1±0.7)ml;术后以上3项指标分别降低到(1.3 ±0.6) mm、(1.8±0.9) ml和(0.7 ±0.3)ml.统计学测量显示,眶内壁和下壁的重建误差分别为(2.5±0.6) mm和(2.1 ±0.4)mm.结论 单侧眼眶骨折治疗应用导航系统可以得到精确的眶壁重建和满意的治疗效果.     

预成钛网在伴发眼球破裂眼眶骨折眶壁重建中的应用

目的:通过回顾性分析,总结伴发眼球破裂的眼眶骨折的损伤特点,初步评价预成钛网在其眶壁重建中的应用效果。方法:2004-09～2008-05在北京大学口腔医学院创伤中心接受治疗的罹患合并眼球破裂眼眶骨折病例共8例。术前借助计算机软件,基于CT数据,通过镜像的方法制作预成钛网,行眶壁重建术,术后再次CT分析,评价眶壁重建的精确性和眼球突度恢复情况。结果:8例患者7例在眶壁重建前由眼科完成眼球摘除,1例与眶壁重建同期完成。所有病例均成功的实施了眶壁重建,术后未发生严重并发症。CT分析显示,该组病例在眼球内陷、眶壁缺损、骨性眶腔扩大和眶内软组织疝出等方面均较严重。手术后,眶内软组织疝出体积平均减小2.7 ml,整体眶腔容积平均缩小2.9 ml,87.5%(7/8)的病例眼球内陷矫正至3 mm以内。结论:伴发眼球破裂的眼眶骨折具有创伤严重、骨性眶腔扩大显著和眶内软组织体积降低明显等特点,预成钛网的应用可达到较为精确的眶壁重建。     

眶壁颌面部复合性骨折的早期手术治疗

在严重复合性颌面部骨折中，伴眶壁缺损者并不少见。如第一次手术处理不当，骨折片不能精确复位、眶壁缺损未能修复，将会造成眼眶容积增大，眼球内陷、复视、面部畸形等难以矫正的后遗症。笔者通过对伴有眶壁缺损的颌面部复合性骨折行早期手术治疗，用钛板作眶缘及颧骨上颌骨内固定联合钛网及硅胶板做眼眶重建，取得了良好的效果。现将我院2002-2004年收治的16例眶壁颌面部复合性骨折早期手术治疗的病例进行总结。     

非单纯性眼眶骨折眶腔容积改变与眼球内陷相关性研究方法初探基于CT图像数据的计算机辅助测量

目的应用计算机辅助三维CT影像分析系统，测量分析非单纯性眼眶骨折术前术后眶腔容积变化，为定量诊断和矫治骨折继发眼球内陷探索可行性研究方法。方法2004年10月～12月北京大学口腔医院颌面创伤中心经治的7例颅颌面创伤合并单侧非单纯性眼眶骨折。投照薄断层（0．625mm）CT，将图像数据以DICOM格式输入图像分析软件，对眼眶及眶内容物进行三维重建。描述眶腔破坏特征。测量眼球突度、原骨折和虚拟恢复眶外缘后的眶腔容积，并做术前术后比较分析。结果应用该系统可形象直观地显示眼眶畸形部位、范围。定量明确眼眶体积扩大量。在该类眼眶骨折中，骨折可波及整个眶壁。与眶缘骨折相比较，眶壁骨折与眼球内陷关系密切。术前术后比较，眼球内陷得到不同程度的改善，健患侧眼眶体积之差进一步缩小。结论基于CT图像数据的计算机图像分析系统可以清晰直观的显示出骨折眶壁畸形，以及健患侧眶腔体积的差异。球前和球后眶腔容积差可以为进一步探求眼眶破坏与眼球内陷的相关关系及量化诊断提供重要参数。     

眼眶骨折标准诊断CT层面的确定与应用研究

目的:确定跟眶骨折的CT标准诊断层面,描述CT标准层面上的眼眶形态.方法:42侧正常眼眶和21例单侧骨折眼眶,摄取CT数据,输入图像软件.在设定的CT标准诊断层面上描述眶底、眶内壁、两者交界区的形态特征.与手术所见对照,评价眼眶骨折在标准层而的检出率.结果:设定9个标准层面.在4个矢状层面上,眶底形态靠外侧呈Ⅰ型,靠内侧呈Ⅱ型.圆孔层面眶底最深[男性(36.26±4.72)mm,女性(34.81±4.76)mm].在3个冠状层面上,眶内下壁交角由前向后逐渐增大,男性分别为(128.33±19.11)°、(132.57±22.17)°和(137.44±20.87)°,女性分别为(129.55±22.32)°、(134.95±25.50)°和(139.46±22.80)°.在轴位层面上,眶内/外缘到视神经管内口内/外壁距离男性分别为(38.47±4.41)mm和(47.13±4.10)mm,女性分别为(38.21±5.63)mm和(45.79±5.41)mm.冠状层面的眶底和眶内壁骨折检出率93.75%～100%,9个层面的总检出率为100%.结论:提出的9个CT标准层面可作为眼眶骨折的常规诊断层面.     

眼球缺失伴眶壁骨折的重建

由于外伤原因摘除眼球后造成眶窝凹陷,采用义眼台植入和义眼修复是常规矫治方法[1].但对于合并大范围眶壁骨折者,即使眶内植入义眼台,配戴义眼后仍会出现上睑沟加深、眼窝凹陷、上睑退缩等畸形,即使加厚义眼也难以改善外观,被称为眶内容物缺失综合征[2].首都医科大学附属北京同仁医院口腔科通过一例眼球缺失伴眶壁骨折患者的病情分析、手术设计及疗效观察,对眼球缺失伴眶壁骨折患者眶壁重建的必要性、手术时机、手术方法进行分析讨论.     

眼眶骨折继发眼球内陷手术矫治与疗效相关因素的探讨

眼眶骨折是常见的颅颌面损伤类型之一,可单独或与颅颌面其他骨折同时发生.眼眶骨折可分为单纯性骨折(pure orbital fracture)和非单纯性骨折(impure orbital fracture)[1],前者是眶缘完整,仅眶壁发生骨折;后者为眶缘、眶壁联合骨折,多为颧骨复合体、鼻-眶-筛以及额骨骨折合并的眼眶骨折.Stoll[2]总结264例眼眶骨折,其中单纯性眼眶骨折占21%,非单纯性眼眶骨折比例为79%.Manolidis 等[3]总结96例111侧非单纯性眼眶骨折,其中50%合并颧骨复合体骨折,32%合并鼻-眶-筛骨折,28%合并额骨骨折.单纯性眼眶骨折主要为拳击伤或摔伤,而大多数非单纯性眼眶骨折为交通事故伤[3-4].Seider等[4]总结非单纯性眼眶骨折眼球内陷的发生率是单纯性眼眶骨折的5倍.     

114 例眼眶骨折分析

目的:探讨眼眶骨折的诊断和治疗原则。方法:回顾分析了114例眼眶骨折的患者,分类统计其临床表现和治疗方法。结果:眼球运动障碍、复视和眼球内陷发生率分别为63.2%、62.3%和59.6%;视神经损伤、泪道损伤和眼球破裂的发生率分别为15.8%、15.8%和12.3%。95.6%的患者接受了眶壁整复和人造骨植入术;72.8%的患者进行了骨折复位内固定术;部分患者进行了视神经减压术、眼球修补术和泪道手术。结论:眼球运动障碍、复视和眼球内陷是眼眶骨折的主要临床表现,视神经损伤、眼球破裂和泪道损伤亦不能忽视;眶壁整复和人造骨植入术是眼眶骨折治疗的主要术式,非单纯性眼眶骨折还需行骨折复位内固定术。     

眶区骨折的诊断和治疗

眶区居面中部上份 ,位置显要而结构复杂。当眶区遭到打击时可使眼及颌面部的重要功能出现障碍 ,并影响面部外形。对眶区外伤后畸形原因的认识是颌面部创伤研究的重要进步。眶区骨折正日益受到重视 ,但因骨折的发生变异较大 ,可一处或多处 ,也可能是颌面部骨折涉及眶区的一部分 ,明确分类甚是困难。可按骨折部位分成眶尖、眶缘及各眶壁骨折 ;也可按骨折性质分为眶爆裂性骨折和非爆裂性骨折。若从颌面外科角度而言 ,按骨折部位及特点将眶区骨折分为眶内骨折 (即爆裂性骨折 )及眶缘骨折两大类 ,后者包括眶缘及构成各眶壁骨骼的骨折 ,临床上常见…     

Evaluation of maxillofacial injuries by use of computerized tomography

The use of computerized tomography (CT) in the evaluation of maxillofacial injuries is described. It is helpful in the assessment of mid-face trauma, fractures of the orbital walls, and potential airway obstruction. Cases are presented to illustrate some of its advantages over conventional radiographs.     

Frequency of maxillofacial injuries in all-terrain vehicle collisions.

PURPOSE: We sought to evaluate the frequency and distribution of maxillofacial injuries associated with all-terrain vehicle (ATV) collisions and to compare this with patients involved in motorcycle accidents over the same 5-year period at the University of Alabama at Birmingham.Patients and methods The records of all patients involved in ATV collisions who were admitted to the University of Alabama at Birmingham Trauma Center from January 1998 to January 2003 were reviewed. Age, gender, mechanism of injury, length of stay, Glasgow Coma Scale (GCS) score, maxillofacial injuries, Injury Severity Score (ISS), and maxillofacial Abbreviated Injury Scale (AIS) score were the factors considered for the study. These variables were also analyzed for patients involved in motorcycle collisions who sustained maxillofacial trauma. RESULTS: There were a total of 72 ATV collisions; 23 patients (32%) sustained maxillofacial injuries. The mean age was 31, and there were 59 males (82%) and 13 females (18%). The most common mechanism of injury was an ATV rollover. The warmer seasons and weekend days had the highest frequency of ATV trauma. Of the 23 patients who sustained maxillofacial injuries, the average maxillofacial AIS score was 2. The length of stay and GCS score were 8 days and 12, respectively, compared to 5 days and 15 in the nonmaxillofacial injury group. The most common maxillofacial fracture seen was a zygomaticomaxillary complex fracture (n = 8), followed by mandibular fractures (n = 6), and orbital floor blowout fractures (n = 5). Eighty-three percent of patients with maxillofacial injuries required an operative intervention during their hospitalization. The distribution of maxillofacial fractures in the ATV group was similar to that of an equivalent motorcycle group, but the frequency for the ATV group was higher (32% versus 8%). The length of stay for the motorcycle group was 11 days versus 8 days for the ATV group. The GCS scores, maxillofacial AIS scores, and ISS were similar between the 2 groups (12, 2, and 18, respectively). In patients who sustained maxillofacial fractures, neurologic injuries were the most frequent concomitant injury in the ATV group, whereas orthopedic injuries occurred more often in the motorcycle group. CONCLUSIONS: Maxillofacial injuries are common findings in ATV collisions. ATV patients with maxillofacial fractures have more neurologic impairment at admission and longer hospitalizations than patients sustaining motorcycle injuries. There needs to be an increase in the public health effort to educate individuals about the dangers of ATVs and to provide proper safety guidelines before the purchase of a vehicle.     

Ocular and periocular injuries associated with an isolated orbital fracture depending on a blunt cranial trauma: anatomical and surgical aspects

The anatomical location of fractures following blunt cranio-orbital trauma is important for neurosurgeons and maxillofacial surgeons. In this study, 588 cranio-orbital fractures following blunt trauma were evaluated retrospectively with regard to the anatomical site and surgical treatment. Orbital cranial nerve injuries and the outcomes of the medical and/or surgical treatment are described. Distribution of the zygomatic complex and orbital fractures were as follows: zygomatic complex fractures (n:304), isolated orbital fractures (n:58), complex comminuted fractures (n:226). In 58 cases, 69 orbit fractures were found (11 bilateral and 47 unilateral fractures). The lateral wall was the most frequent fracture (n:63). The least frequent fracture was the roof of the orbit (n:11). The accompanying lesions were as follows: 89.65% of cases were associated with periorbital haematoma (n:52), 13.79% of cases with retrobulbar haemorrhage (n:8), 96.55% cases with periorbital soft tissue oedema (n:56), 53.45% cases with pneumocephalus (n:31), 8.62% cases with intra-parenchymal contusion (n:5), 6.89% cases with enophthalmia (n:4), 5.17% of cases with rhinorrhoea (n: 3), 5.17% cases with optic bulb injury and adnexial trauma (n:3), 32.76% cases with intra-orbital emphysema (n:19), and 20.69% with vision dysfunctions (n:12), of whom 2 had no optic nerve injury.     

A systematic review of the diagnostic role of ultrasonography in maxillofacial fractures

This systematic review assessed the diagnostic value of ultrasonography in maxillofacial fractures. A computerized literature search of MEDLINE, PubMed and GoogleMed databases was conducted for publications on diagnostic ultrasound and maxillofacial fractures in English. Search phrases were ‘maxillofacial fractures’ or ‘midfacial fractures’ or ‘zygomatic complex fractures’ or ‘nasal bone fractures’ or ‘orbital fractures’ or ‘mandibular fractures’ combined with ‘ultrasound’ or ‘ultrasonography’. The Boolean operator ‘AND’ was used to narrow the searches. 17 articles published between 1992 and 2009 were reviewed: two on midfacial fractures, nine on orbital fractures, three on nasal fractures, and two on mandibular fractures. One article described case series of ultrasonographic diagnosis of mandibular and midfacial fractures. The sensitivity and specificity of ultrasound in detecting orbital fractures were 56-100% and 85-100%, respectively, whilst that of nasal fractures were 90-100% and 98-100%, respectively. Sensitivity and specificity of ultrasonography in detecting zygomatic fractures were >90%. For mandibular fractures, the sensitivity and specificity was 66-100% and 52-100%, respectively. Much evidence justifies the use of diagnostic ultrasonography in maxillofacial fractures, especially fractures involving the nasal bone, orbital walls, anterior maxillary wall and zygomatic complex. The sensitivity and specificity of ultrasonography is generally comparable with CT.     

Maxillofacial fractures sustained by unmounted equestrians

Facial injuries caused by horses are relatively common among riding enthusiasts, but little is known about the nature of maxillofacial fractures sustained by those not mounted. We collected data on patients’ characteristics, fractures sites, mechanisms of injury, and treatment of these fractures from the departmental records of the oral and maxillofacial unit at Christchurch Hospital, New Zealand between 1996 and 2008. Of 49 patients with equine-related facial fractures, 35 (mean (SD) age 35.8 (16.7) years) had sustained their injuries while unmounted (71%). Most of the fractures occurred in women (66%), of whom 39% were aged between 16 and 30 years. There was an increasing trend in the incidence of these fractures over much of the 13-year period. Most injuries were caused by kicks (69%), followed by head-butts (26%), and trampling (6%). The zygoma was the most common fracture site (63%), followed by the mandible (34%), and orbital floor (31%). Surgical intervention was required in 60% of cases.     

COMPUTED TOMOGRAPHY IMAGING STRATEGIES AND PERSPECTIVES IN ORBITAL FRACTURES

Objective:

The objective of this study was to demonstrate the sensitivity and specificity of multislice computed tomography (CT) for diagnosis of orbital fractures following different protocols, using an independent workstation.

Materials and methods:

CT images of 36 patients with maxillofacial fractures (symptomatic to orbit region) who were submitted to multislice CT scanning were analyzed, retrospectively. The images were interpreted based on 5 protocols, using an independent workstation: 1) axial (original images); 2) multiplanar reconstruction (MPR); 3) 3D images; 4) association of axial/MPR/3D images and 5) coronal images. The evaluated anatomical sites were divided according to the orbital walls: lateral (with or without zygomatic frontal process fracture); medial; superior (roof) and inferior (anterior, medial). The collected data were analyzed statistically using a validity test (Youden''s J index; p<0.05). The clinical and/or surgical findings (medical records) were considered as the gold standard to corroborate the diagnosis of the anatomical localization of the orbital fracture.

Results:

3D-CT scanning presented sensitivity of 78.9%, which was not superior to that of MPR (84.0%), axial/MPR/3D (90.5%) and coronal images (86.1%). On the other hand, the diagnostic value of axial images was considered limited for orbital fractures region, with sensitivity of 44.2%.

Conclusions:

Except for the axial images, which presented a low sensitivity, all methods evaluated in this study showed high specificity and sensitivity for the diagnosis of orbital fractures according to the proposed methodology. This protocol can add valuable information to the diagnosis of fractures using the association of axial/MPR/3D with multislice CT.     

颌面部骨折142例临床报告

目的:总结分析颌面部骨折的病因、临床特点及治疗方法。方法:对中国医科大学附属口腔医院2004年10月-2005年9月收治的142例颌面骨骨折患者,分别从其年龄、性别、病因、骨折类型、全身损伤、治疗及手术并发症等各方面,进行综合分析研究。结果:颌面部骨折好发于男性,20～50岁为好发年龄段;交通事故损伤最常见(59.15%);多见下颌骨骨折(50.00%)及颧骨复合体骨折(29.58%);常伴发全身损伤(35.21%);治疗中复位后坚固内固定术是最佳方法(81.65%);手术切口以口内为主(58.72%);术后神经损伤及感染极少见。结论:颌面部骨折以青壮年居多,最主要病因是交通事故,除复位颌间牵引保守治疗外,复位后坚固内固定是现今临床最常用的治疗方法。