眶底爆裂性骨折致眼球运动障碍的上颌窦手术进路治疗

目的 观察上颌窦进路手术治疗眶下壁爆裂性骨折所致眼球运动障碍的临床效果.方法 对12例12只眼眶下壁爆裂性骨折伴复视及眼球运动障碍者,眼眶CT显示:眼外肌眶内软组织嵌顿于眶下壁骨折区,伤后观察2周,复视及眼球运动障碍无明显改善,采用上颌窦进路行眶下壁骨折复位术.术后随诊3～6个月.结果 12例患者术中开放上颌窦后可清晰观察到眶下壁骨折区各个边界及眶内软组织嵌顿情况,术中均将嵌顿在眶底骨折处的眶内组织推送回眶内,眶底骨折复位.术后12例患者中10例各方向眼球运动不受限,无复视,2例正前方及下方无复视,向上方运动轻度受限.术后1例并发上颌窦炎,经上颌窦冲洗治愈.结论 上颌窦进路早期治疗单纯眶下壁爆裂性骨折所致眼球运动障碍是有效的.

Treatment of ocular motility disturbance due to orbital floor blow-out fracture via caldwell-luc approach

Objective To observe the ophthalmologic outcome of Caldwell-Luc approach for treatment of ocular motility anomalies due to orbital floor blow-out fracture.Methods Review of 12 patients with vertical diplopia、restriction of ocular motility and CT scan finding of entrapment of the inferior rectus muscle and intra orbital tissue at the fracture site.There were no significant improvement of diplopia and ocular motility anomalies during the acute phase(within two weeks of injury).12 cases were treated via Caldwell-Luc approach.Postoperatively,they were followed up for 3-6 months.Results Orbital floor fractures and entrapped intra orbital tissue were clearly observed via Caldwell-Luc approach.Entrapped soft tissue were released and returned into orbit,and floor fractures were repaired.Postoperatively,disappearance of dipiopia was reported by 10 patients,two patients had slight reduced motility and diplopia in up gaze.One case with maxinary sinusitis,cured by irrigation of maxillary sinus with antibiotic solution,no other complications were found.Conclusion Caldwell-Luc approach for ocular motility anomalies of pure orbital floor fractures is an effective treatment in the early stages.