鼻眶筛区复杂骨折的处理

目的 总结鼻眶筛区（NOE）复杂骨折处理的经验。介绍两种单侧内眦韧带复位固定的新方法。方法 1983-2001年共收治NOE复杂骨折患者289例，分别按伤情行初期，延期和晚期手术，手术方法主要通过原伤口或冠状切口，口内切口和下睑缘下切口联合入路；根据不同类型分为解剖复位（初期），正颌外科矫正和植骨或植骨代用品修复（延期或晚期）；单侧内眦韧带撕脱移位采用“拴马桩式”或“抽屉式”复位固定术。结果 本组病例全部救治成功，功能和面容明显改善。“拴马桩式”和“抽屉式”复位固定术。结果 本组病例全部救治成功。功能和面容明显改善，“拴马桩式”和“抽屉式”单侧内眦韧带复位固定新方法效果较好。结论 将NOE骨折分为爆裂型，震碎型，塌平型，塌陷型和颅面分离型有助于选择治疗方法，应在掌握手术适应证的情况下，进行比较专业的初期手术或延期手术；晚期处理需综合应用颅面外科，正颌外科，整形外科，坚强内固定，柱骨或植骨代用品等技术。

Treatment of complicated naso-orbital-ethmoid fractures

Objective To summarize the treatment experiences of the complicated naso-orbital-ethmoid (NOE) fractures and introduce two reduction fixation techniques for unilateral medial canthal ligament injury. Methods There were 289 cases of complicated bone fractures treated with different operations in different stages (primary, delayed and secondary stages) according to their conditions between 1983 and 2001. The surgical approaches were mainly combination incision through original wound, coronal incision, intraoral incision, and marginal incision of the lower eyelid. The methods included anatomic reduction (primary stage), orthognathic surgery, and repair through bone grafting or artificial bone substitute (delayed or secondary stages). For the avulsion of unilateral medial canthal ligament, hitching post- and drawer-like reduction fixation methods were employed. Results All cases were cured successfully, function improved significantly, and traumatic deformities corrected. The classification of 5 types for complicated NOE fractures, i.e., blow out, vibrated-comminuted, flattened, concaved, cranial-face separated, was used for treatment design. Re-attachment to the unilateral medial canthal ligament by two new methods was satisfactory. Conclusions Complicated NOE fractures should be professionally treated in the primary and delayed stages under a control of the surgical indications. Treatment in the secondary stage needs multi-techniques including cranio-maxillofacial surgery, orthognatic surgery, plastic surgery rigid internal fixation and bone grafting or artificial bone substitute.