爆裂性眶壁骨折伴眶内容嵌顿的手术治疗

爆裂性眶壁骨折较为常见,但发生眶内容嵌顿较少见.当眼外肌发生嵌顿时,易致复视,须手术复位,以达到理想视力及眼位.近年我们诊治了爆裂性眶壁骨折导致眼外肌嵌顿4例,术后效果良好.现报告如下.     

经睑下缘及内眦切口内镜辅助下眶壁骨折治疗初探

目的 探讨经睑下缘径路内镜辅助下手术治疗眶壁骨折的可行性.方法 对2例外伤所致的眶壁骨折患者,经睑下缘及内眦切口内镜辅助下分离嵌顿的眼肌,于眶下壁及眶内壁置入钛板.结果 1例患者术后复视消失,术后视力1.2,无下降.1例患者术后仍有眼球内陷及复视,术后左眼视力由0.25提高到0.6,右眼仍为1.0.结论 经睑下缘及内眦切口内镜辅助手术治疗眶壁骨折视野清楚,操作准确,无严重的手术并发症发生.     

经鼻爆裂性眶骨折眼球内陷的晚期整复

目的研究眼眶爆裂性骨折眼球内陷晚期手术整复的方法及疗效。方法回顾性总结1998～2002年不同人路手术治疗19例眼眶爆裂性骨折患者的手术疗效。结果17例患者的眼球内陷得到不同程度的矫正,2例治疗无效。术后复视症状完全消失4例,部分消失5例,无变化6例。结论眼眶爆裂性骨折眼球内陷的晚期重建复位手术获得满意疗效。     

眼眶爆裂性和非爆裂性复杂骨折经鼻人路的手术治疗

目的 探讨眼眶爆裂性骨折和非爆裂性复杂骨折的诊断与经鼻入路手术整复的方法及疗效.方法 回顾性总结2000-2009年经鼻入路手术治疗的41例眼眶骨折(爆裂性和非爆裂性复杂骨折分别有35例和6例)患者的诊断方法及手术疗效.患者主要表现为复视、眼球内陷及颌面部畸形等.手术方法主要包括:鼻内镜经鼻腔筛窦入路手术修补筛窦型,经鼻腔外侧壁入路修补上颌窦型,联合进路修复筛上颌窦型;鼻内镜与颅、颌面、鼻腔联合进路修复眶-上颌-颧弓复杂骨折.结果 35例爆裂性骨折术后29例复视消失,6例术后轻度复视,其中4例术后6个月恢复正常,另外2例仍有轻度复视.33例眼球内陷者术后即完全矫正,2例术后改善为轻度内陷.非爆裂性骨折眶-上颌-颧弓复杂骨折6例,4例术后复视和眼球内陷消失,颌面骨外形基本恢复正常,1例轻度复视和眼球轻度内陷,1例无复视有眼球轻度内陷,颌面骨外形轻度改变.结论 经鼻入路手术可有效治疗眼眶爆裂性骨折和非爆裂性复杂骨折所致的眼球内陷和复视,且该术式具有术中组织损伤小,并发症少的优点.     

外伤性眶壁骨折的治疗

目的：探讨外伤性眶壁骨折的治疗方法。方法：本组共32例，其中2例保守治疗，余30例于鼻内窥镜下手术复位治疗，使其复视、视力下降、眼球内陷均得到较好的矫治。效果：30例中，19例眼球内陷，28例复视，30例视力下降，经治疗眼球内陷及复视均消失，视力都有不同程度的提高。结论：鼻内窥镜下手术复位眶壁骨折并回纳疝出的眶内容物是治疗外伤性眶壁骨折的有效方法。     

眶壁暴裂性骨折的影像诊断（附12例分析）

本文报告12例眶壁暴折的影像诊断,其中下壁型5例,内壁型1例,底内壁型6例。卡瓦氏位片诊断率为83％,断层片诊断率为92％,CT和MRI均为100％。作者认为卡瓦氏位片是一个简单而有效的方法,卡氏位适于内壁型,瓦氏位适于下壁型骨折的诊断。CT诊断率高(尤其是冠状面扫描),能清晰地显示骨折及眶内容物脱出的程度。MRI对显示眼外肌和眶内脂肪状态优于CT。     

眶爆裂骨折的CT诊断及临床意义

眶爆裂骨折是指眼眶内，下壁骨折，即筛蝶窦外侧壁及上颌窦上壁骨折，鼻眼相关疾病。本文报告２１例眶爆裂骨折，其中单纯型４例，复型１７例。文章对发病机理、ＣＴ的表现及手术适应证等进行了分析及讨论。认为ＣＴ是诊断眶爆裂骨折最精确的方法，可行骨穿及软组织窗扫描，本病的主要信息多靠冠状面扫描，故仅行横断面扫描是不能解决诊断问题的。爆裂骨折根据临床及影像学所见可行保守或手术治疗，ＣＴ的诊断对手术的选择及判断预捕     

经上颌窦径路修复眶下壁骨折伴眶内容脱垂及下直肌嵌顿

探讨经上颌窦径路鼻内窥镜下眶下壁骨折伴眶内容脱垂及下直肌嵌顿复位及手术修复的疗效。     

导航辅助鼻内镜下眶壁骨折复位术

眶壁骨折是眼科最常见的一种外伤,轻度眶壁骨折不伴复视不需手术,严重的颌面部外伤需眼科、耳鼻咽喉科及口腔科合作进行联合整复,单纯眶内侧壁及眶下壁骨折伴复视的患者既往需眼科行鼻外筛窦入路或睑缘下切口进行手术,但随着鼻内镜外科的发展单纯眶下壁及内侧壁骨折可在鼻内镜下完成。但因眶内侧壁骨折突到筛窦的组织有时只有一小部分,有时很难判断骨折部位,导航辅助鼻内镜则使这一操作变得简单易行,现将我科与眼科合作的6例患者报告如下。1对象与方法1.1临床资料1.1.1一般资料2005年10月～2006年12月共开展导航辅助鼻内镜眶壁复位手术6例,…     

Endoscopic endonasal or transmaxillary repair of orbital floor fracture: a study of 88 patients treated in our department.

Objective—Endoscopic repairs of orbital floor fractures performed in our department were reviewed and postoperative outcomes were assessed. Material and Methods—The subjects comprised 88 patients who underwent surgery between 1991 and 2001, 14 of whom had trapdoor fractures. Endoscopic repair was performed when diplopia did not improve after 1 week of conservative treatment. Fractures were repaired via endonasal or transmaxillary routes and fixed with a urinary bladder catheter. Results—The postoperative course was evaluated on the basis of change in diplopia. After surgery, diplopia resolved in 79.5% of patients but remained, especially on upward gaze, in 20.5% of patients. Residual diplopia was more common in patients with trapdoor fracture. Conclusions—Endoscopic endonasal and transmaxillary repairs were effective and less invasive methods for freeing orbital tissues trapped by fragments of fractured bone and for restoring smooth ocular movements. However, suspected trapdoor fractures should be repaired within 1 week after injury in order to prevent fibrosis from developing in orbital tissues owing to entrapment by bone fragments.     

鼻内镜下鼻中隔软骨修复治疗爆裂性眼眶内侧壁骨折

目的：探讨鼻内镜下鼻中隔软骨修复治疗爆裂性眼眶内侧壁骨折的临床效果。方法：在鼻内镜下将骨折复位,将眶内容物还纳,以自体鼻中隔软骨植入骨折缺损处修复眶壁缺损,观察患者手术前后视力、复视、眼球突出度和眼位变化。结果：术后随访3个月～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：鼻内镜下鼻中隔软骨修复爆裂性眼眶内侧壁骨折具有手术人路简捷、视野清晰、操作简便、损伤小、无面部瘢痕等优点,效果确信可靠。     

击出性骨折的诊断及治疗(附18例报告)

目的 提出击出性骨折的诊断及治疗水平。方法 回顾性总结分析我科1999年1月-2001年8月收拾的击出性骨折病人18例，其中眼球内陷15例，复视13例，眼球运动障碍7例，视力下降1例，眶下神经支配区感觉异常5例。2例采用保守疗法，另16例均行手术治疗。根据骨折类型采用经上颌窦、经眶下、经内镜下鼻内开筛进路眶壁整复手术。结果 随访0.5-1年，18例病治愈15例（83.3%)，好转3例（16.7%）。结论 术前详细检查及合理术式的选择是提出击出骨折疗效的关键。     

A stepwise surgical technique using the medial orbital floor as the key landmark in performing endoscopic sinus surgery

HYPOTHESIS: The medial orbital floor (MOF) and adjacent bony ridge of the antrostomy, when combined with columellar measurements, are easily identifiable and consistent anatomic reference points from which critical orbital and skull base structures can be found during endoscopic sinus surgery. METHODS: Two examiners, with varying endoscopic sinus surgery experience, performed endoscopic and direct measurements from the columnella and medial orbital floor to critical orbital and skull base structures on 11 human cadaver heads (18 sides). The distances to four critical skull base or orbital structures and to the anterior and posterior wall of the sphenoid sinus were measured. The mean, ranges, and standard deviations for all measurements (endoscopic and direct) were calculated and simple regression analysis was performed. RESULTS: The mean and range of values for each of the variables correlated well between examiners, and between endoscopic and direct measurements. There was slightly more variability in measurements when the MOF was used. However, the differences were no more than a few millimeters and did not appear to affect the overall clinical use of these values. CONCLUSIONS: The MOF and adjacent bony ridge of the antrostomy, when combined with columellar measurements, are easily identifiable and consistent anatomic landmarks that are not affected by the presence of significant inflammatory disease or previous surgery. These reference points provide even the most inexperienced surgeon with precise anatomic localization within the paranasal sinuses. They also determine the correct anteroposterior trajectory into the sphenoid sinus, whereby inadvertent intracranial or intraorbital complications may be avoided.     

The differences of blowout fracture of the inferior orbital wall between children and adults

OBJECTIVES: To review the clinical features and recovery period of patients with blowout fractures of the inferior orbital wall treated surgically and to examine the differences between children and adults. DESIGN: A retrospective study. SETTING: Department of Otorhinolaryngology, Maryknoll General Hospital, Busan, Korea.Patients Medical records of 70 patients were reviewed: 16 patients were children (aged <16 years) and 54 were adults (aged >or=17 years). MAIN OUTCOME MEASURES: Symptoms and fracture patterns were compared between both groups in all subjects, and the recovery period relative to the timing of surgery after the trauma was compared in subjects who complained of diplopia or extraocular limitation. RESULTS: Serious periorbital edema was noted in 43 adults (80%) and 4 children (25%), diplopia in 27 adults (50%) and 16 children (100%), and extraocular muscle limitation in 23 adults (43%) and 13 children (81%). Trapdoor fractures were frequent in the children group (n = 13; 81%), whereas 30 patients (56%) had open-door fractures in the adult group. In the children group, no differences in the recovery period relative to the timing of surgery was noted when all types of orbital fractures were considered. However, among the 13 children with trapdoor fractures, the recovery period was significantly shorter in those who underwent surgery 1 to 5 days after the trauma compared with those who underwent surgery after 6 to 14 days and 15 days or longer. In adults, the recovery period of those who underwent surgery 1 to 5 days and 6 to 14 days after the trauma were significantly shorter compared with those who underwent surgery after 15 days or longer. CONCLUSIONS: Diplopia, extraocular muscle limitation, and trapdoor fractures were more frequent in children than in adult patients. After trauma, surgical intervention might be required within 5 days in children with trapdoor fracture vs within 2 weeks in adults.     

鼻内镜下眼眶内侧壁骨折的复位及重建的效果研究

目的探讨鼻内镜下眼眶内侧壁骨折复位及其重建的效果。方法回顾性分析2009年10月-2013年10月诊治的10例眼眶内侧壁骨折患者的临床资料,分析其眼眶内侧壁骨折复位及接受重建手术的诊治过程,并术后随访观察。结果 10例眼眶内侧壁骨折患者均接受骨折复位及重建手术,2周后所有患者鼻腔眼眶内部异物反应消失,无溢泪现象,且脸部恢复情况较好,眼球整体恢复情况较好,无1例出现眼球内陷症状,手术3个月内复视现象基本恢复,无严重并发症。结论眼眶内侧壁骨折患者采用鼻内镜下重建手术方案,能够有效缩短患者手术恢复时间,且手术操作比较方便,创伤较小,符合现代美容学要求,值得推广。     

儿童眶底骨折的特点及治疗

本文报道应用CT扫描诊断的20例儿童眼底骨折的特点与治疗经验。男性15例,女性5例,年龄4～14岁。其中撞击伤12例,车祸5例,摔伤3例。手术治疗17例,保守治疗3例。眼球陷没治愈率100％;复视治疗成功率95％,失败率5％。本文就儿童眼底骨折的特点、诊断和治疗、手术适应证及手术方法进行讨论,认为早期诊断、早期治疗及术后早期运动训练是此病获得治愈的关键。     

慢性鼻-鼻窦炎在内镜手术后不填塞的可行性研究和适应证探讨

目的：探讨功能性内镜鼻窦手术（FESS）后不做填塞的安全性和可行性,并对适应证进行研究。方法：对74例慢性鼻窦炎患者（不填塞组）在FESS术后不进行填塞（保障措施包括：适当的病例选择,术前和术后抗炎,止血药物治疗,术中减少损伤,术后细致的防粘连处理）,并与填塞组（20例）进行对比分析。结果：不填塞组在FESS术后均无严重出血发生,术后渗血在2～6h内基本停止;在3个月的随访期内无术腔严重粘连发生。结论：采取适当的处理和预防措施,大多数FESS术后患者可不进行填塞,这可明显减轻患者的术后痛苦,降低治疗成本,也使患者对FESS治疗的依从性增加。