下睑缘入路治疗眶内下壁联合骨折

目的评价采用下睑缘切口治疗眶内、下壁联合骨折的效果。设计回顾性病例系列。研究对象18例眶内、下壁联合骨折的患者。方法所有患者均经下睑缘切口行眶壁骨折整复术,术中充分游离、保护泪囊,于眶内、下壁浅面植入复合羟基磷灰石人造骨片,术前、术后行双眶水平及冠状位CT、头面部三维cT检查并进行比较。主要指标临床症状及并发症。结果术后随访3～18个月,所有患者下睑皮肤瘢痕不明显,术后均未出现人造骨片排异或移位,无一例患者术后出现溢泪,复视、眼球内陷等症状均得到改善。结论单独采用下睑缘切口治疗眶内、下壁联合骨折是可行的,但仅适于眶下壁联合眶内壁下份骨折,尤其是伴发眶内、下壁隅角骨折的复合型骨折。

Surgical repair of medial orbital wall combined with orbital floor fracture via lower lid subciliary approach

Objective To assess the effect of surgical repair of medial orbital wall combined with orbital floor fracture via lower lid subciliary approach. Design Retrospective case series. Participants 18 cases of medial orbital wall combined with orbital floor fracture. Methods All patients underwent the reconstruction of orbital wall via lower lid subciliary approach. The composite hydroxyapatite was implanted into the surface of medial orbital wall and orbital floor after lacriminal cyst was completely dissected and protected during the operation. Orbital axial and coronal CT, three-dimension CT scan have been used in all the cases preoperalively and postoperatively. Preoperative CT was compared with postoperative CT. Main Outcome Measures Clinical symptoms and complications. Results All patients were followed up for 3 to 18 months. The postoperative scar of infracillary skin was not obvious. The composite hydroxyapatite was not rejected and dislocated in all cases postoperatively. No postoperative epiphora was found in either case. Preoperative diplopia and enophthalmos were corrected. Conclusion The treatment of medial orbital wall combined with orbital floor fracture via an isolated lower lid subciliary approach was feasible. But the incision was only used in the treatment of inferior medial orbital wall combined with orbital floor fracture, especially the transition area fracture between the orbital floor and medial orbital wall.