单纯型眶壁爆裂骨折晚期畸形的诊断及整复

目的：探讨眶壁爆裂骨折所致眶壁畸形、眼球内陷的发生机制及其整复手术。方法：应用三维CT影像学技术及计算机三维诊断系统，观察眶壁畸形特征，测量眶腔容积变化，分析眼球内陷和复视的发生机制。并采用自体骨或羟基磷灰石人工骨植人恢复眶腔容积的方法进行整复。结果本组11例，未出现植人骨感染、外露等并发症。其中10例眼球突出度、眼球运动功能恢复，复视得以矫正，眶、眼睑外形良好；1例复视未得到矫正，眼球运动功能恢复欠佳。结论：眶壁爆裂骨折眼球内陷的原因主要是眶腔容积增大、眶内容疝出，还纳眶内容后植骨恢复眶腔容积，是治疗此类畸形的有效方法。

Three-dimensional diagnostics and surgical correction of late deformities of orbital blowout fractures

Objective To investigate the mechanisms of enophthalmos and deformities of orbital walls in patients with orbital blowout fracture and to evaluate the reconstructive surgical methods. Methods The features of orbital deformities, the change of orbital volume and the mechanisms of enophthalmos were measured and analyzed by means of 3-D CT technique and 3-D diagnostic computer-assisted system. The reconstructive operations were employed on these 11 cases with orbital blowout fractures to correct deformities and restore orbital volume by applying autogenous bone grafts or hydroxyapatite bone substitutes. Results There were no serious complications such as infection of bone graft, exposure of hydroxypatite implant in all 11 cases, 10 cases got satisfactory appearance of eyelids and orbit, of which thediplopia and enophthalmos were corrected with protrution of eyeball restoring normally. 1 case remained diplopia after surgical correction. Conclusions The enophthalmos is mainly caused by orbital volume enlarging and orbital content herniating into paranasal sinuses. Implanting autogenous grafts and hydroxyapatite substitutes to restore orbital volume are proved to be effective.