爆裂性眼眶骨折早期和晚期临床及CT表现特征

目的观察爆裂性眼眶骨折早期与晚期的临床及CT表现特征。方法前瞻性研究。通过检查记录和随访观察，收集2012年6月至2013年8月来郑州大学第一附属医院就诊的39例爆裂性眼眶骨折患者的早期（受伤7 d内）和晚期（受伤34 d左右）临床表现及CT征象。回顾性总结其致伤原因主要为拳击伤18例（46%），其次为车祸伤9例（23%）。结果39例患者早期视力下降13例（33%），眶周软组织淤血肿胀38例（97%），眼球凹陷≥2 mm有6例（15%），眼球运动障碍及复视17例（44%），眶下神经麻痹15例（38%）。晚期视力下降4例（10%），无眶周软组织淤血，眼球凹陷≥2 mm 26例（67%），眼球运动障碍及复视5例（13%），眶下神经麻痹无好转2例（5%）。CT早期表现：折断端清晰锐利35例（90%）；眼外肌增粗36例（92%），移位31例（79%），边缘模糊不清33例（85%）；鼻窦积液30例（77%），眶内积血积气5例（13%）。CT晚期表现：骨折断端模糊柔和28例（72%）；眼外肌肿胀36例（92%），移位改善31例（79%），边缘模糊不清2例（5%），无眶内积气积血。结论爆裂性眼眶骨折早期具有眶周软组织淤血肿胀，骨折断端清晰锐利、眼外肌边缘模糊不清、鼻窦积液、眶内积血积气等特征；晚期具有眼球凹陷，骨折断端模糊不清、眼外肌边缘光滑等特征；掌握其特征对于眼眶爆裂性骨折的诊断及法医学鉴定、临床治疗具有重要意义。

An analysis of clinical and CT features in early and later phase of orbital blowout fracture

Objective To observe the clinical and CT features of early and later phase in patients with orbital blowout fracture （BOF）. Methods A prospective record and follow-up of 39 patients with orbital BOF were presented with the clinical manifestations and CT signs of early and later phase in First Affiliated Hospital of Zhengzhou University between June 2012 and August 2013. Main causes of 39 patients with orbital BOF were the boxing injury （46%）, followed by traffic accident injury （23%）. Results The ocular findings of earler stage （in a mean 2.9 d）： were visual deterioration in 13 cases （33%）, the periorbital extravasated blood and swelling in 38 cases （97%）, eye sunken 〉12 mm in 6 cases （15%）, eye movement disorder and diplopia in 17 cases （44%）, infraorbital nerve palsy in 15 cases （38%）. The ocular symptoms of later stage （at a mean 34 d） were visual deterioration in 4 cases （10%）, the periorbital extravasated blood and swelling no one, eye sunken ≥2 mm in 26 cases （67%）, eye movement disorder and diplopia in 5 cases （13%）, infraorbital nerve palsy in 2 cases （5%）. The early stage CT signs were the orbital wall fracture in 39 cases （100%）, extraocular muscles thickening in 36 cases （92%）, extraocular muscle gression in 31 cases （79%）, the edge of the extraocular muscle was rough in 33 cases （85%）, nasal cavity hydrops in 30 cases （77%）, orbital pneumatosis and hematoma in 5 cases （13%）. The later stage CT signs were the orbital wall fracture in 39 cases （100%）, extraocular muscles thickening in 36 cases （92%）, extraocular muscle gression in 31 cases （79%）, the edge of the extraocular muscle was rough in 2 cases （5%）, nasal cavity hydrops and orbital pneumatosis and hematoma no cases. Conclusion BOF have some characteristics in early stage such as the periorbital extravasated blood and swelling, clearand sharp of fracture end, rough edge of the extraocular muscle, nasal cavity hydrops and orbital pneumatosis and hematoma. In the later stage BOF have other characteristics such as eye sunken, ambiguous fracture end and smooth edge of extraocular muscle. Knowing these differences and features will be beneficial to the diagnosis, medicolegal expertise and the clinical treatment.