眼眶爆裂性骨折致肌肉嵌顿手术治疗.docVIP

眼眶爆裂性骨折致肌肉嵌顿手术治疗 　 作者：赵 红，孙丰源，李青吉，孟 斌 【摘要】 目的 探讨眼眶爆裂性骨折复视的手术治疗。方法 对外伤后出现复视及眼球内陷患者进行CT扫描，观察眼眶壁骨折及眼外肌受累程度，Hertel突眼计测量眼球内陷度数，同视机及三棱镜等眼肌学检查分析复视情况，采用前路经结膜或经睫毛下皮肤切口入路分离松解嵌顿及粘连的眼外肌，并用多孔聚乙烯眶内植入修复眶壁缺损，矫正眼球内陷。去除限制因素3个月后，用同视机及三棱镜分析复视及眼球运动情况，残余斜视采用眼肌手术或三棱镜矫正。结果 95例眼眶爆裂性骨折复视患者经眶壁骨折修复术治疗后，术后第一眼位无复视者84例(88.4%)，第一眼位有复视者11例(11.6%)。因第一眼位和功能眼位复视要求治疗者共14例(14.7%)，其中行眼外肌手术者6例，配三棱镜矫正8例。结论 眼眶爆裂性骨折所致的复视大部分可经过眼眶爆裂性骨折修复术得以矫正，少数下直肌或内直肌受损较严重者方需二次眼外肌手术或三棱镜矫正。 【关键词】 爆裂性骨折；复视；手术治疗 【Abstract】 Objective To evaluate the effect of surgical treatment on diplopia caused by blow-out fractures.Methods Reviewed and summarized 95 cases of blow-out fracture treated by surgery， which was taken CT scan to determine the degree of the fractures and extraocular muscle injuries. Analyzed the diplopia by extraocular muscle examination. Surgery was directed at freeing the adhesion or entrapment muscles and reconstituting the orbital shape and volume. 3 months after operation，analyzed the diplopia and movement of the eye ball. Remainder diplopia was rectified by extraocular muscle operation or tri.Results In 95 cases of blow-out fractures with diplopia，which were treated by orbital surgeries，84 cases without diplopia at the first eye location，11 cases with diplopia.14 patients asked for treatment for diplopia at first eye location or functional location.There were 6 patients were taken extraocular muscle surgery，and 8 patients were taken triple prism.Conclusion Orbital surgical management is an effective mean of diplopia caused by blow-out fractures.Most of them could be successful repaired，a small percentage of them which muscles were injured severity need muscle surgery or triple prism. 【Key words】 blow-out fracture；diplopia；surgical treatment 爆裂性骨折是常见的眼眶外伤，近年发生率有上升的趋势。由于该病所致的眶壁损伤及眼外肌的嵌顿与粘连，临床上出现不同程度的眼球运动障碍及复视。自2002年12月～2004年9月我科共收治115例眼眶爆裂性骨折患者，其中95例伴有复视或代偿头位，经眼眶手术得以治疗，现报告如下。 1 资料与方法 1.1 一般资料 天津市眼科医院住院患者，眼眶爆裂性骨折伴有复视或代偿头位的患者95例，其中男73例，女22例；年龄为5～54岁，平均28.5岁。致伤原因分别为拳击伤、钝器伤、车祸及爆炸伤等。 1.2 临床检查 95例手术病人