眼眶爆裂性骨折的CT评估

目的分析眼眶爆裂性骨折的临床表现及CT所见，探讨陈旧性眼眶骨折的CT征象鉴别。方法对239例（241眼）眼眶爆裂性骨折的临床症状和体征以及CT征象进行回顾性分析。结果本组单纯眼眶内侧壁骨折130例（132眼，55．77％），单纯眶下壁骨折31例（31眼，12．86％），双眶壁骨折63例（63眼，26．14％），混合型骨折15例（15眼，6．22％）。眼外肌增粗182条，眼眶内容物疝入副鼻窦28例，眶内出血43例，眶内积气39例，副鼻窦积液142例，眼睑及眶周软组织肿胀176例。发生复视86例，发生眼肌活动障碍125例，发生眼球内陷27例。本组病例中，受伤超过3个月者复查22例（22眼），发生眶壁骨质凹陷共30眶壁，眶腔扩大伴眼球内陷13例，眼外肌增粗共21条。结论CT扫描是评估眼眶爆裂骨折及其预后的首选检查方法。眼眶内侧壁骨折最为常见；眼眶陈旧性骨折眶壁呈凹陷性改变；骨折程度严重可致眶腔增大、眼球内陷；眼外肌增粗可长期存在。

CT evaluation of orbital blowout fracture

Objective To analyzed and summarized clinical situations and CT signs of orbital blowout fracture, deeply investigate CT signs of old orbital blowout fracture. Methods 239 patients with orbital blowout fracture proved by CT scan from December 2004 to October 2006 were retrospectively analysed their CT signs and clinical sings and symptoms. Results In the study of 239 eases （241 eyes）, the orbital blowout fracture of simple medial wall,simple inferior wall and multi walls were respectively in 130 cases （132 eyes）, 31 eases （31 eyes） and 63 eases （63 eyes）, Complicated fracture were identified 15 cases, extraoeular muscles thickening were 182 eases, orbital content hernia into accessory nasal cavity were 28 eases, intraorbit hemorrhage were 43 eases, intraorbit pneumatosis were 39 cases, accessory nasal cavity hydrops were 142 cases, soft tissue where surrounding of orbit and eyelid engorgement were 176 cases. Diplopia,muscular apparatus dyscinesia,and endophthalmos were respectively in 86 cases, 125 cases, and 27 cases. Injured above three months in these study were 22 cases, orbital wall hollowed 22 eyes 30 orbital cavity enlargement accompany enophthalmos were 13 cases, extraocular muscles thickening were 16 cases 21 strips. Conclusion CT scan was the first election for examine method that to evaluate orbital blowout fracture and prognosis. Medial orbital wall fracture was the most common orbital blowout fracture; orbital wall became hollow in old orbital blowout fracture; orbital cavity enlargement accompany enophthalmos were resulted in severity fracture; extraocular muscles thickening may exist a long term.