早期牵引治疗眼眶爆裂性骨折所致复视临床疗效观察

目的 观察早期牵引治疗眼眶爆裂性骨折所致复视临床疗效,探讨牵引治疗适应证.方法 回顾性观察眼眶爆裂性骨折病52例52只眼.其中38例经药物治疗无效后应用手法行牵引治疗.随访期为6个月.结果 38例患者经牵引治疗后27例复视症状消失,4例好转,7例无效.未见治疗引起的并发症.结论 早期牵引治疗眼眶爆裂性骨折所致复视方法简单,有效,是一种较为实用治疗方法.     

眼眶下壁骨折术后长期复视原因分析

目的 分析眼眶骨折手术失败的原因.方法 眼眶下壁骨折术后长期复视12例临床资料进行回顾性研究.结果 12例眶下壁骨折主要表现为垂直复视及眼球内陷.均行手术治疗.术后表现为复视加重并长期不缓解;术后计算机断层成像(CT)显示其中9例存在骨折后缘分离不彻底,存在医源性嵌顿;2例楔形眶底材料使用者植入材料位置靠前,造成眼球上移位;1例儿童骨折存在术后再粘连及肌腹上抬现象.结论 手术中彻底的分离并还纳眶内组织,正确的植入位置及防粘连措施是眼眶骨折手术成功的重要因素.     

Complications following orbital floor fractures

Complications after orbital floor fractures were studied in 76 cases (follow-up time 4 years). The following procedures were performed by the maxillofacial surgeon: repositioning of the orbital floor, tamponade of the maxillary sinus, covering of the defect with Lyodura, autologous bone grafting, and balloon catheterization. A satisfactory result was achieved after the primary operation in 75% of the cases. In cooperation with the ophthalmologist a variety of complications in 19 patients were studied and analyzed. The results of this study show the necessity of diagnostic and surgical cooperation between the specialists concerned.     

Diplopia in fractures of the orbital floor

Based on their own experience with surgical treatment of 43 patients with fractures of the orbital floor, the authors discuss the problem of early operation in relation to the development of residual diplopia. They evaluate the functional result by the size of the visual field where diplopia occurred. In confirmed fractures of the orbit they recommend operation as early as possible after the injury. All patients were operated by the method of transantral reposition of the orbital floor. Satisfactory functional results were achieved in all operated patients. None of them had diplopia in the primary position of the eyes. The best results were achieved in patients operated early (residual diplopia in 10%), where none of the patients had diplopia in the visual field beneath 30 degrees.     

眼眶骨折修复手术后残余复视的手术矫正

目的 探讨眼眶骨折修复手术后主要功能视野内消除复视的手术时机、方法和效果。方法 筛选眼眶骨折修复手术后,对残余复视进行手术矫正的40全（40眼）进行回顾性研究。分析不同患者复视的成因,手术时机及手术方法的选择。术后随访6个月对手术疗效进行评价。结果 40例术前存在Ⅲ级复视,行眼外肌手术。根据被动牵拉试验结果,选择直肌后徒悬吊、截除以及Jensen联结、眶骨膜固定等术式。术中25例角膜映光基本正位,主要功能视野内无复视,10例略过矫,5例欠矫。术后6月观察,27例主要功能视野无复视;7例正前方无复视,但下方视野残留复视;6例第一眼位残留复视,给予配戴压贴三棱镜后复视改善。结论 眼眶骨折修复术后消除主要功能视野复视的手术方法应根据术前和术中牵拉试验结果以及眼球运动检查来选择,合理的手术方式可有效地消除复视、改善眼球运动功能。     

Management of blow-out fractures of the orbital floor

The management of orbital fractures has long been controversial. In some cases, surgical repair is required, and early repair is more successful than secondary reconstruction. In other cases, slow resolution of diplopia over four to six months obviates surgery. In an editorial and two separate articles, the authors elucidate indications for and results of the early vs. late surgical repair of orbital blow-out fractures.     

高密度多孔聚乙烯种植体修复眼眶下壁骨折

目的探讨高密度多孔聚乙烯种植体（Medpor）修复眶下壁骨折效果。方法做睫毛下切口,充分暴露眼眶骨折部位、松解嵌顿的眶内容物,骨膜下填充Medpor修复眶下壁骨折。观察术后复视、眼球运动、眼球内陷等症状改善情况及植入物有无脱出及感染。结果随访期内未出现Medpor脱出或排斥现象。全部21例（21只眼）术后均无明显的眼球内陷,19眼复视消失,2眼复视明显改善。结论Medpor填充是眶下壁骨折有效治疗方法。     

Blowout fracture of the orbital floor with entrapment caused by isolated trauma to the orbital rim

There are two main theories on the cause of blowout fractures of the orbit: the "hydraulic" theory and the "buckling force" theory. Although both mechanisms have been shown responsible for experimental blowout fractures, the role of isolated rim trauma in producing clinical blowout fractures with entrapment of orbital soft tissues continues to be questioned. I examined a 69-year-old patient who developed a blowout fracture with clinical evidence of entrapment after isolated trauma to the orbital rim. Five days previously the patient had had a cataract extraction and implantation of an intraocular lens in the ipsilateral eye, which remained undisturbed by the trauma. This case supports the role of a buckling force to the rim in producing orbital blowout fractures. Review of the circumstances of injury in large series of blowout fractures suggests that this mechanism may be operative in the majority of cases.     

早期手术治疗眼眶爆裂性骨折的视功能评估

目的探讨早期眼眶爆裂性骨折Medpor填充治疗效果,评估术后患者的视功能恢复情况。方法回顾28例（28只眼）眼眶爆裂性骨折患者的病例资料,观察患者手术前术后视力、眼球突出度、眼外肌运动及复视等情况。结果术后随访3个月至4年,28例患者术后均未出现患眼明显视力下降和视力丧失,术后眼球内陷度数为（1.5±0.6）mm,与术前（3.6±1.1）mm相比,差异有统计学意义（P〈0.05）。术后3个月,25例患者复视完全消失,2例患者第一眼位无复视,但仍有周边复视,1例术后第一眼位复视仍存在。26例术后眼球运动基本恢复正常,2例外展稍受限,但较术前好转。以上28例患者均未发现填充物移位、感染或排异反应。结论早期诊断、早期治疗及术后早期运动训练,是治疗效果的关键。Medpor填充治疗眼眶爆裂性骨折所致复视、眼球内陷,临床效果安全可靠。     

小儿眶底骨折临床分析

目的 :探讨小儿眶底骨折的临床特点及治疗。方法 :回顾性研究 6 7例年龄小于 18岁的单纯眶底骨折患者 ,采用手术治疗眶底骨折 ,植入物为硅胶或羟基磷灰石。结果 :体育运动 (37 3% )和暴力伤 (2 3 9% )是造成小儿眶底骨折的主要原因 ;79 1%的病人有眼球运动疼痛和 /或恶心呕吐 ,复视 (79 7% ) ,严重的眼球运动障碍 (6 1 2 % )和眼球内陷 (2 5 4% )。小儿眶底骨折主要是陷阱型 (trapdoortype)骨折 (5 6 8% ) ,可伴有下直肌嵌顿。早期手术 (<1个月 )比晚期手术 (>1个月 )可以更有效地改善患者症状 (P <0 0 5 )。结论 :早期手术是治疗小儿眶底骨折的有效方法