眶颧复合体骨折合并眶底骨折的手术治疗

目的 评价颧眶复合体骨折合并眶底骨折的手术治疗效果.方法 对81例眶颧复合体骨折合并眶底骨折患者根据骨折时间及部位选择性地采用冠状切口、下睑缘切口、口内切口,复位、固定骨折并行同期眶底重建.所有患者术前、术后均摄双眶水平及冠状位CT、头面部三维CT像,并进行比较.结果 术后随访6～37个月.平均12.5个月,所有患者面形基本对称,开口度正常,58例复视基本消失,5例有不同程度改善;66例眼球内陷者中,60例基本矫正,4例内陷＜2 mm,2例内陷2～3 mm.3例出现轻度下睑外翻,2例巩膜暴露,无人造骨片排异和移位出现.结论 颧眶复合体骨折合并眶底骨折应根据患者症状确定是否行眶底探查,颧弓及颧蝶缝是骨折复位的重要参考点.

The surgical treatment of orbitozygomatic complex fracture combined with orbital floor fracture

Objective To assess the effect of surgical treatment of orbitozygomatic complex fracture combined with orbital floor fracture. Methods Eighty-one cases of orbitozygomatic complex fracture combined with orbital floor fracture underwent open reduction and reconstruction of orbital floor. The coronal,subciliary,intraoral approach were used selectively during the operation according to the time and types of fractures. Orbital axial CT and coronal CT ,three-dimension CT scan had been used in all cases preoperatively and postoperatively. Preoperative CT was compared with postoperative CT. Results Facial symmetry and normal mouth opening were obtained postoperatively. Preoperative diplopia and enophthalmos were corrected. Conclusions The exploration of orbital floor should be determined according to the patient's symptom for the orbitozygomatic complex fracture combined with orbital floor fracture. The zygomatic arch and sphenozygomatic suture were key reference points for reduction of fractures.