鼻眼联合手术入路治疗爆裂性眶底骨折31例

目的探讨鼻眼联合手术入路治疗爆裂性眶底骨折的临床效果。方法 31例(31眼)爆裂性眶底骨折,采用下睑睫毛下切口入路和经上颌窦柯-陆氏入路,分别在直视下和鼻内窥镜下联合修复眶底骨折,解除粘连和嵌顿,还纳眶内容物。观察手术前后患者眼球突出度、复视程度、眼球牵拉试验及眼外肌功能的改善情况,分析手术疗效。结果 31例(31眼)爆裂性眶底骨折手术前均存在眼球凹陷,患眼与健眼眼球突出度相差4.0～8.0(5.0±1.3)mm,差异具有统计学意义(t=6.798,P=0.000);正前方及前下方视野内均有垂直复视;31眼眼球牵拉试验结果均为阳性(眼球向上被动牵引时存在阻力),眼球向上和向下运动均明显受限。手术后3个月,31眼眼球凹陷均得到满意恢复,患眼与健眼眼球突出度相差0～1.0(0.3±0.5)mm,差异无统计学意义(t=1.309,P=0.200)。手术前后自身患眼眼球突出度比较,相差2.0～5.0(3.0±0.1)mm,差异具有统计学意义(t=4.956,P=0.000);31眼中28眼正前方复视消失,16眼前下方复视消失;31眼眼球牵拉试验结果均为阴性(眼球向上被动牵引时不存在阻力),眼球上转均恢复正常,15眼仍有下转受限。结论鼻眼联合手术入路修复爆裂性眶底骨折,术野暴露充分,手术损伤相对较轻,临床效果可靠,尤其适用于严重的大范围眶底骨折患者。

Combined surgical approach via nose and eye for crack orbital floor fracture of 31 cases

Objective To investigate the clinical effect of combined surgical approach via nose and eye for crack orbital floor fracture.Methods Thirty-one patients(31 eyes) with crack orbital floor fracture received operation to repair the fracture through inferior eyelids approach under eyelashes and maxillary sinus Ke-Lu approach under direct vision and nasal endoscope,the adherence and incarceration were released,and the orbital contents were resetted.The degree of proptosis,ocular motility,forced retraction test,and diplopia before and after surgery were observed to analyze the clinical effect.Results Before the surgery,enopthalmos exited in all 31 patients,the difference of exophthalmos between the injury eye and contralateral eye was 4.0-8.0(5.0±1.3)mm,there was significant difference(t=6.798,P=0.000);Vertical diplopia existed in front field and down-gaze;Positive forced retraction test(pulling the eye upward with resistance) in all 31 patients;And abnormal eye vertical movement appeared in up-gaze and down-gaze.At 3 months after surgery,enophthalmos of 31 patients were corrected satisfactorily,the difference of exophthalmos between the injury eye and contralateral eye was 0-1.0(0.3±0.5)mm,there was no statistical difference(t=1.309,P=0.200).The difference of exophthalmos before and after surgery were 2.0-5.0(3.0±0.1)mm,there was significant difference(t=4.956,P0.000);The vertical diplopia of front field disappeared in 28 patients,and diplopia of down-gaze disappeared in 16 patients;All 31 patients had negative forced retraction test(pulling the eye upward with no resistance);The eye movement of all 31 patients recovered normal in up-gaze,but 15 patients had still abnormal eye movement in down-gaze.Conclusion Combined surgical approach via nose and eye for crack orbital floor fracture can get good exposure,subtle injury,and obvious effect,is suitable for serious crack orbital floor fracture.