经鼻填充鼻中隔软骨修复眶内侧壁骨折.docVIP

经鼻填充鼻中隔软骨修复眶内侧壁骨折 【摘要】 探讨应用鼻内镜填充鼻中隔软骨，修复眶内侧壁骨折，经鼻做眼部手术的可能性。方法：选取眶内侧壁骨折患者11例（11眼），术前检查均有不同程度的眼球内陷、复视、视力减退症状，行眼眶CT诊有眶内容物疝入筛窦并伴积液，其中6例内直肌肿胀。手术开始在内镜直视指引下，经鼻腔开放筛窦，摘除筛房，暴露骨折的纸板，将疝入物回纳眶内，鼻中隔软骨覆盖骨折区。结果：患者手术后全部治愈。双眼突出度相差≤1?mm，平均0.11?mm。视力较术前不改变或者略有改善。鼻内镜检查见筛窦术腔上皮化，填充的鼻中隔软骨无移动，无感染及排斥现象。结论：经鼻填充鼻中隔软骨修复眶内侧壁骨折方法简便，成功率高。自体鼻中隔软骨无排斥反应。 【关键词】 眶骨骨折 鼻内镜手术 筛板 鼻中隔 ［ABSTRACT］ Objective: To explore the possibility of transnasal endoscopic management of septal cartilage augmentation in repairing medial orbital wall fracture. Methods: Eleven patients (11 eyes) with medial orbital wall fracture were enrolled in this study. Before surgery, all the patients had more or less enophthalmos, diplopia and hypopsia. Eye socket CT examination showed that ocular contents were herniated into the ethmoid sinus accompanied with hydrocele. Among them, 6 patients had medial rectus swelling. Under endoscopy, ethmoid sinus was opened via the nasal cavity, the ethmoid cells were extirpated to uncover the fractured lamina, herniated contents were returned back to the eye socket, and the fracture zone was overlaid with septal cartilage. Results: All were cured after surgery. The exophthalmos of both eyes was less than 1?mm (with a mean of 0.11?mm). The eyesight of the patients showed no change or was slightly improved. Nasal endoscopy showed epithelization of nasal and sinus cavities and unshift augmented septal cartilage. There was no infection or rejection. Conclusion: Transnasal endoscopic management of septal cartilage augmentation in repairing medial orbital wall fracture is simple, quick and has a high success rate. Autogenous septal cartilage has no rejection response. ［KEY WORDS］ Orbital fracture; Endoscopic surgical procedures, operative; Cribellum; Septal cartilage 由于鼻、眼解剖的相关性，两者在外伤、炎症、肿瘤等疾病的发生、发展和转归方面，存在着紧密的联系。我科在熟练掌握鼻眼相关手术解剖的基础上，应用内镜技术，探索经鼻内进路完成鼻眼区域的部分手术。2002年1月至2005年10月，我科采用鼻中隔软骨做眶内侧壁骨折修补术，疗效良好，现报告如下。 1 资料与方法 1.1 临床资料 经CT扫描诊断的爆裂性眶壁骨折57例,其中眶内壁骨折患者11