眼眶壁爆裂性骨折合并眼球破裂内陷的矫治

目的探讨眼眶壁爆裂性骨折合并眼球破裂内陷的治疗方法。方法在行羟基磷灰石义骨板整复眼眶壁爆裂性骨折联合眼球摘除及义眼台植入术的同时,达到1次手术矫正眼窝凹陷的目的,共治疗11例(11眼),观察5月～3年。结果全部患者术后眼窝凹陷矫正,术后1眼眼窝轻度凹陷,更换定制义眼外观改善。结论本法通过1次手术使合并眶壁爆裂性骨折的眼球破裂内陷患者外观显著改善,临床效果较好。     

鼻内窥镜下以中鼻甲修复纸板爆裂性骨折1例

探讨纸板爆裂性骨折修复固定方法，对1例单纯眶纸板爆裂性骨折行鼻内窥镜下以中鼻甲修复固定，术后症状消失，经2年随访，眼球内陷稳定在2mm以内，无并发症发生，此法操作简单，效果肯定。     

眼眶爆裂性骨折的研究现状及进展

眼眶爆裂性骨折是眶部挫伤所致的眶壁骨折,由Mackenzie于1844年首先提出,Smith和Regan于1957年命名,它系由直径大于眶口（有人提出直径大于5cm）的物体钝性打击眼眶软组织和眶缘,使眶内压突然升高,引起眶壁最薄弱处（如眶内壁和下壁）向外爆裂所致,而眶缘完整。由于常伴有眶内容物疝出或嵌顿可产生复视、眼球运动障碍、眼球凹陷、眶下神经知觉消失等临床表现,其发病机制目前有两种学说,即眶内流体压力增高学说和眶底扣压学说。     

可吸收材料治疗眶壁骨折可行性研究

目的探讨可吸收材料在爆裂性眶壁骨折修复中的安全性及可行性。方法选取自2016年1月至2017年12月北部战区总医院眼科收治的43例(45只眼)单纯性眶壁骨折患者为研究对象,所有患者均行可吸收材料植入修复。术后复查眼眶三维CT评价植入可吸收材料解剖复位的准确性,比较术前与术后临床资料,评价可吸收材料在治疗单纯性眶壁骨折的可行性。结果术后12个月,90.7%(39/43)眼球运动障碍得到改善,93.3%(28/30)眶下神经知觉减退,76.9%(10/13)眼球内陷得以矫正。所有患者术后视力较术前未见明显变化。术后随访期间,所有患者均未出现上睑下垂、下睑退缩、眼眶感染、植入物排斥或移位、脱出;1例患者术后出现溢泪,在给予消肿、泪道冲洗治疗后症状在术后1个月时好转。术后复查CT可见可吸收网板的位置均比较理想,眶下壁和眶内壁骨折得到了准确的解剖复位。结论应用可吸收材料修复单纯性眶壁骨折安全有效。     

眶窦联合入路治疗眼眶爆裂性骨折

探讨爆裂性眶骨骨折的诊断方法，手术进路及新材料应用。CT扫描是检查爆裂性眶骨骨折最好的方法，眶窦联合入路是严重眶下壁骨折最佳术式，聚乙烯生物材料修复眶骨骨折是目前最好的选择材料之一。     

眼眶骨折微型钛板塑形内固定整复术的疗效观察

目的探讨微型钛板塑形内固定整复术,在三维CT重建技术的指导下,治疗眼眶骨折的临床效果。方法术前行横断面、冠状面二维CT扫描和三维CT重建,根据三维CT重建图像,采用微型钛板塑形内固定,对17例眼眶骨折患者进行骨折复位及眼眶骨缺损整复手术。结果17例术后复视及眼球运动障碍均消失,眼球内陷纠正,视力无损害,且面部外观满意,无植入体轮廓阴影或阶梯状畸形。CT扫描复查眼眶骨折及缺损处修复良好,软组织完全回纳,钛板无移位。术后随访3个月~1年,钛板无排斥反应、移位、感染及其他不良反应。结论微型钛板塑形内固定整复术,充分利用钛板具有的良好生物相容性、坚固强度大、可塑形但又不易变形、体内植入可永久留置等特点,达到眶缘结构良好的固定作用。同时在三维CT重建技术的指导下,眶骨骨折诊断更准确,手术更精确,盲目操作风险性更小,手术时间缩短,大大提高了手术安全性。     

合理选择人工植入体修复创伤后颅颌面骨折畸形

骨折后遗留的颅颌面畸形多因骨折段错位愈合、骨不连接或缺损引起,修复比较困难.其中以眼眶为中心的畸形多存在眶壁塌陷、眶腔扩大、眼球内陷、复视等症状.     

眶-上颌-颧骨骨折手术治疗情况分析

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...     

儿童眼眶骨折的临床与CT分析（附40例报告）

笔者分析４０例儿童眼眶骨折。受伤原因以撞伤、摔伤多见，拳击伤少见。主要表现为视力下降甚至失明、复视及眼球运动障碍。ＣＴ检查常规为水平位及冠状位扫描。主要ＣＴ表现为眶壁骨质连续性中断，占７１．４％眶壁移位眶腔扩大占２８．６％；眶壁直接骨折最多达５０．５％，爆裂骨折占３３．３％，复合骨折占１６．７％；各壁骨折发生率依次为内壁、下壁、外壁及上壁；此外骨折局部可伴有软组织增厚及眼外肌改变。初步认为儿童眼眶     

内联多孔羟基磷灰石在眶内骨折中的应用

由于外伤或眶内肿物造成眼球内陷,临床上并不少见。目前有多种修复眶骨骨折性眼球陷没的技术。1994年9月,我们用眶底骨膜下植入羟基磷灰石人工骨,取得满意效果。报告如下。 1 对象与方法 1.1 对象眼眶骨折病人18例,其中男11例,女7例。年龄20～57岁。右眼12例,左眼6例。视     

Computed tomography in the evaluation of orbital fractures

Orbital fractures should be evaluated by CT in frontal and transverse planes. The significance of blow-out floor and medial wall fractures is discussed. Limitation of inferior rectus muscle mobility is thought to be a result of edema, enophthalmos, fat prolapse or scar tissue formation, rather than muscle incarceration. The consequent therapeutic attitude implies a rigorous preoperative exploration by CT or for some orbital floor fractures by MR.     

The CT characteristics of orbital blowout fracture and its medicolegal expertise

To explore the CT characteristics of orbital blowout fracture, we reviewed 76 cases with orbital blowout fracture and analyzed their clinical forensic characteristics. The missed diagnosis rate of cranial CT was 26.3%, and plain X-ray was 47.4%. The orbital CT examination has advantages in diagnosing orbital blowout fracture. In 42 cases fractures were simple medial orbital wall fracture, 30 cases were inferior orbital fractures. Loss of clinical signs included local haematoma, bone continuity, and displacement of bone fragments were mostly seen in CT image. Clinical signs and symptoms included local haematoma, whilst diplopia as the most common clinical symptom. Visual acuity was rarely affected after fracture. It is concluded that orbital blowout fracture may be misdiagnosed if only cranial CT and plain X-ray are used. Diagnose the orbital blowout fracture only by craniocerebral CT and head X-ray. Orbital CT should be done if the clinical signs are suggestive of orbital blowout fracture Visual acuity was affected and diplopia may be present.     

Evaluation of coronal CT findings of rare cases of isolated medial orbital wall blow-out fractures

OBJECTIVES: To report rare cases of isolated medial orbital wall blow-out fractures and to evaluate their coronal CT findings. METHODS: Nine cases of medial orbital wall blow-out fractures, diagnosed by coronal CT in a general medical hospital between 1995 and 1999, were studied. CT was performed using direct coronal acquisition with a slice thickness of 5 mm. Images were obtained at bone window settings. Clinical examination findings from the medical records were used to give information on the cause of injury, ocular symptoms and the days after injury that the CT examination was performed. RESULTS: Most of the patients (67%) were young male adults. The cause of injury was most frequently the result of fist fighting or athletics (78%). Diplopia and/or limitation of the gaze were the main ocular symptoms (78%). The average time from injury to CT examination was 4 days (range 0-16 days). Seven of the nine patients with medial orbital wall fractures had isolated medial orbital wall blow-out fractures. Herniation of orbital contents toward the ethmoid sinus was observed among all nine fractures. Only three patients (33%) had a swelling and/or medial deviation of the medial rectus muscle, all three having isolated medial orbital wall blow-out fractures. CONCLUSIONS: Nine cases of medial orbital wall blow-out fractures were examined, seven of which were isolated medial wall blow-out fractures. CT findings of this type of fracture included herniation of the orbital contents toward the ethmoid sinus. However, swelling and/or medial deviation of the medial rectus muscle was also seen.     

Direct oblique sagittal CT of orbital wall fractures

Direct oblique sagittal CT was used to evaluate trauma to 77 orbits. Sixty-seven orbital wall fractures with intact orbital rims (36 floor, 22 medial wall, nine roof) were identified in 47 orbits. Since persistent diplopia and/or enophthalmos may warrant surgical repair of orbital floor fractures, optimal imaging should include an evaluation of extraocular muscle status, the nature and amount of displaced orbital contents, and an accurate definition of fracture margins. For orbital floor fractures, a combination of the direct oblique sagittal and direct coronal projections optimally displayed all fracture margins, the fracture's relationship to the inferior orbital rim and medial orbital wall, and the amount of displacement into the maxillary sinus. Inferior rectus muscle status with 36 floor fractures was best seen on the direct oblique sagittal projection in 30 fractures (83.3%) and was equally well seen on sagittal and coronal projections in two fractures (5.5%). Floor fractures were missed on 100% of axial, 5.5% of sagittal, and 0% of coronal projections. Since the direct oblique sagittal projection complements the direct coronal projection in evaluating orbital floor fractures, it should not be performed alone. A technical approach to the CT evaluation or orbital wall fractures is presented.     

MR imaging of orbital blow-out fractures

We report on a case of orbital blow-out fractures involving the medial and inferior walls. In this case conventional multiplanar 8 mm thick sections with magnetic resonance (MR) imaging proved to be more helpful than 1.5 mm axial thin sections with CT in demonstrating the extent of orbital floor herniation of fat. Entrapment of muscle was excluded. Oblique sagittal views were most helpful in evaluating the orbital floor, since the full course of the inferior rectus muscle is seen. Additionally, the optic nerve is seen along its entire length. Masking of intraorbital contents by isodense hemorrhage on CT studies apparently is not a problem with MR imaging if hemorrhage is small or nonacute.     

Measurement of orbital volumes following trauma using low-dose computed tomography

We describe a simple CT technique for the assessment of enophthalmos and measurement of orbital volumes following trauma. The technique uses original diagnostic CT images, standard CT software and involves no additional radiation dose or scan time. The results of this technique in 66 patients with orbital trauma are presented. The incidence of post-traumatic enophthalmos was significantly raised in association with combined blow-out fractures of the floor and medial wall of the orbit and where orbital blow-out fractures occurred in conjunction with zygomatic injury. Patients without bony imjury had a traumatised orbit volume less than 1 cm³ greater than the non-traumatised side in all cases. Intra-observer reproducibility of the measurement of difference in volume between traumatised and non-traumatised orbit was ± 0.3 cm³ (1 SD). In patients with fracture, increase in orbital volume by more than 2 cm³ compared with the contralateral orbit was strongly associated with enophthalmos (sensitivity 100%, positive predictive value 69%). We conclude that routine volumetric assessment following orbital trauma provides a clinically useful, objective assessment of the risk of post-traumatic enophthalmos and that an increase in orbital volume greater than 2 cm³ is an indication for surgical repair.Correspondence to: R. W. Whitehouse     

视神经管骨折的CT诊断

本文对８５例视神经管骨折的临床与ＣＴ所见进行了回顾性分析。受伤原因中车祸３６例，撞伤１３例，摔伤１１例，击伤或砸伤１２例，其他伤少见。均有明显视力下降，其中失明无光感达７８例。８５例均行骨算法高分辨率ＣＴ扫描，显示视神经管内壁骨折６６例，内、上壁骨折１１例，上壁骨折３例，粉碎骨折５例，伴有邻近眶壁或蝶窦骨折７１例。视神经管骨折容易造成失明，因此外伤失明的患者早期行ＣＴ检查，对临床诊断及选择治疗方案具有指导意义     

The usefulness of orbital lines in detecting blow-out fracture on plain radiography

The purpose of this study was to assess the diagnostic value of orbital line changes on plain radiographs in detecting blow-out fracture. 92 cases of surgically confirmed blow-out fracture were retrospectively analysed in regard to plain radiographs and CT. Anterior and posterior lamina papyracea lines (ALPL and PLPL, respectively) of the orbital medial wall as well as the posteromedial floor line (PMFL) were assessed on orbital posteroanterior projections. The inferomedial orbital line (IMOL) and the inferior wall line were assessed on Waters projections. Orbital lines on plain radiographs were compared with CT findings. Of 53 cases of lamina papyracea fracture, 47 cases showed orbital line changes on plain radiographs (sensitivity 88.7%). Changes of PLPL (41/47), IMOL (29/47), ALPL (4/47) and PMFL (2/47) were demonstrated as depression, loss, discontinuity and irregularity. In four cases showing normal radiographs, the fractures measured less than 9 mm in size on CT. All 25 cases with orbital floor fracture accompanying medial wall fracture demonstrated orbital line changes of PMFL (16/25), PLPL (14/25), ALPL (3/25) and IMOL (2/25) (sensitivity 100%). 12 of 14 cases with orbital floor fracture demonstrated changes of inferior wall line (7/12) and PMFL (6/12) (sensitivity 85.7%). Two cases demonstrated asymmetric focal soft tissue density without orbital line changes. Orbital line changes on plain radiographs corresponded well with CT findings, confirming the usefulness of plain radiographs in detecting blow-out fracture.