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.

Clinical effect of orbit fracture reconstruction under nasal endoscope

Objective To investigate the clinical effect of orbit blowout fracture reconstruction under nasal endoscope.Methods Forty-one cases of orbit fracture were reconstructed for lost or damaged orbit under nasal endoscope through maxillary sinus,ethmoidal sinus or the both.Results Among the 35 cases of orbit blowout fracture,endophthalmos in 33 cases were completely improved,29 cases were symmetrical to normal eye after operation without diplopia except that 6 cases had slight endophthalmos accompanied with slight diplopia.Among these 6 cases,4 cases returned to normal without diplopia 6 months after operation.In the 6 cases of orbit non-blowout fracture,4 cases were symmetrical to normal eye after operation without endophthalmos,diplopia and facial malformation.One case had slight endophthalmos and diplopia,1 case had slight endophthalmos with slight facial malformation.Conclusions The surgery under nasal endoscope is safe and credible.The method can be easily mastered and its complication is less.