眼眶骨折伴斜视患者的临床诊治分析

目的 分析眼眶骨折伴斜视患者的斜视性质、眼眶骨折修复的手术时机和术后斜视的变化等.方法 回顾分析2001年1月到2008年12月在中山大学中山眼科中心诊治的眼眶骨折患者.常规作眼眶CT检查、被动转动试验、眼位和眼球运动检查、复像试验,观察眼眶骨折修复前后眼位和眼球运动情况等.结果 共87例90只眼,男性66例,女性21例;年龄3～68岁(平均30.6岁);右眶27例,左眶57例,双眶3例.36%的患者有视力受损.32%为眼眶爆裂性骨折,68%为复合性骨折;以内壁和下壁骨折多见.术前47%的患者有斜视,其中麻痹性41.5%,限制性58.5%;眼眶骨折修复后:35例术前有斜视者(平均随访1年),28.6%斜视消失;17.1%正前方和下方功能位置无斜视,37.1%斜视部分好转或不变;17.1%斜视加莺;1例术前无斜视,术后出现医源性斜视.结论 眼眶骨折伤后患眼斜视的性质包括麻痹性和限制性,骨折修复手术时机存在争论,以下情形需要尽快手术:(1)影像学检查显示有眼外肌断裂;(2)CT扣描和被动转动试验均示有明确的眼外肌嵌顿,保守治疗二周无好转;(3)外壁和上壁的Blow-in骨折.眼眶骨折修复术后其斜视既可消失也可不变或加重;医源性斜视要尽量避免.

A clinical analysis of strabismus in patients with orbital fracture

Objective To observe the etiology of strabismus,the timing of surgical orbital repair and final results of deviation after surgical management in patients wim orbital fracture.Methods The clinical data of87patientswith orbital fracture seen between Jan 1,2001 and Dec 31,2008 by the corresponding author in Zhongshan Ophthalmic Center,Sun Yat-sen University were retrospectively analyzed.The position and range of fracture and incarceration of extraocular muscles were determined by CT scanning and forced duction test.Special attention was paid to the strabismus and ocular motility before and after the orbital surgical repair.Results Amongthe 87 cases(90 eyes),there were 66 males and 21 females with their age ranging from 3 to 68 years old(average 30.6 years).The right orbit was involved in 27 cases,the left one in 57 cases and both the right and the left in 3 cases,with 32%being blow-out orbital fracture and 68%being complex orbital fracture.The medial wall and orbital floor were involved more often than the lateral orbital wall and the orbital roof.36%of the cases had visual impairment.Before surgery,patients with strabismus accounted for 47%of them,among which 41.5%were paralytic and 58.5%were restrictive.Afar surgical orbital repair.the strabismus disappeared in 28.6%,only resolved in the functional fields of gaze in 17.1%,had little or no alteration in 37.1% and became worse in 17.1%.One patient got iatrogenic strabismus after surgery that was cured by reopemtion.Conclusions The strabismus after orbital fracture may be either paralytic or restrictive.No definite guidelines exist for the timing of orbital repair.Immediate surgery must be performed in such cases:(1)a missing rectos found on CT findings;(2)obvious extraocular entrapment confirmed by CT scanning and forced duction test and unacceptable diplopia 14 days after injury;(3)blow-in fracture of the lateral orbital wall and the orbital roofwith motility restriction."New dipiopia"may occur after orbital fracture repair in patients with both paresis and restriction of an extraocular muscle and this diplopia may require additional therapy.Iatrogenic deviation ought to be avoided during surgical repair.