陈旧性眶颧骨折合并眼球内陷的治疗
[摘要]目的：探讨陈旧性眶颧骨折后眼球内陷的整复治疗。方法：术前常规行X线检查、眶部轴面及冠状位扫描及三维重建，了解眶颧骨骨折及眶内容物移位嵌顿情况。术中首先暴露骨折部位，将移位的骨折块截骨复位、微型钛板坚强内固定，重建正常的眶缘；用自体或人工材料植入，同时修复眶壁。结果：所有病例眼球内陷均得以明显改善或矫正，颧部外形明显改善，眼球运动功能得以恢复， CT显示眶结构恢复良好，内直肌及下直肌位置及形态正常，视神经无受压。结论：陈旧性眶颧骨折所致晚期眼球内陷畸形可通过截骨复位、植入自体或人工材料重建眶缘，修复眶骨各壁的缺损获得有效矫正。
[关键词]眶颧骨折；眼球内陷；手术治疗
[中图分类号]R622 [文献标识码]A [文章编号]1008-6455(2009)02-0166-03
The treatment of late orbitozygomatic fracture with enophthalmos
WU Guo-ping,HE Xiao-chuan,TENG Li, GUO Li, LI Yue-gang, LIAO Yi, XIONG Ai-bing
(Department of Plastic and Burn Surgery,the Affilated Hospital of Luzhou Medical College,Luzhou 646000, Sichuan,China)
Abstract：ObjectiveTo study the surgical treatment of enophthalmos deformity caused by orbitozygomatic fractures.MethodsX-ray, A coronal and an axial computed tomography scan of the orbit, and three-dimensional CT reconstruction were employed todemonstrate the status of the orbitozygomatic fracture andthe displacement andherniated orbital contents of the patients preoperatively. Following exposed the fractured area, the displaced orbital bones were repositioned after osteotomy and rigid fixed by micro-plate and screws to reconstruct the orbital rim. Then the fractured orbital walls were repaired precisely with autogenous bone and biomaterialwhich were fixed to the area beneath the periosteum.ResultsAll patients had their enophthalmos deformity corrected and regained satisfactory zygomaticofacial appearance with this technique. The movement of the globe recovered well, postoperative CT scan demonstrating orbital walls were reconstructed well, the location and formation of medial and inferior rectus muscle were normal, and there was no optic nerve compressed.Conclusions The late orbitozygomatic fracture with enophthalmos deformity can be corrected or obviously improved by the reduction of displaced bone fragments and precise reconstruction the orbital walls with autogenous bone and biomaterial.
Key words: orbitozygomatic fracture; endophthalmos; surgical procedures
颧骨与眶骨及上颌骨的解剖毗邻关系密切，颧骨骨折特别是由高速直接暴力所致，势必导致邻近骨的骨折。眶颧骨折造成眶壁破坏、眶周骨移位塌陷、眶内容物疝出或丢失。因各种原因早期未得到及时复位固定或治疗不当，当肿胀消退后，由于骨折段的畸形愈合、吸收、瘢痕挛缩牵拉，造成后期眶颧骨以及邻近器官和软组织结构的畸形。而眶颧骨折所致后期眼球内陷一直被认为是该区域创伤后畸形矫正的重点和难点。笔者2004年7月～2008年7月收治颧眶骨折伴眼球内陷27例，采用颅颌面外科技术进行矫正，取得良好效果。
1资料和方法
1.1 一般资料：2004年7月至2008年7月收治颧眶骨折伴眼球内陷27例，男18例，女9例，年龄17～61岁，平均34岁。左侧14例，右侧13例，致伤原因：交通事故伤21例，工伤事故者5例，跌落伤者1例。颧骨颧弓骨折9 例；上颌骨合并颧骨颧弓骨折15例。额眶颧骨折3例。受伤后手术时间：3月～17年。术前主要症状体征：颧部塌陷畸形，眼球内陷，眶下区感觉麻木，其中眼球活动受限者8例，复视者12例，视力下降14例。
1.2 术前检查：术前常规行头颅华氏位及眶骨断层X线检查，以了解构成眶缘骨骼的骨折移位情况及有无眶内容物疝入上颌窦，并初步确定各眶壁的骨折情况。为准确诊断各眶壁的骨折情况，进一步做眶骨轴面及冠状位扫描，确定创伤眶骨的所有畸形，包括不同程度的眶壁缺损，软组织疝入上颌窦，嵌入眶外侧壁，眶内侧壁等眶壁的骨折以及眶内软组织移位于邻近解剖间隙的情况。三维CT重建可准确直观显示眶骨的骨折移位情况，为骨折块的复位及眶骨的修复重建提供参考。
1.3 手术方法:所有患者均在全麻下进行手术。根据拟显露部位及手术需要，分别采用头皮冠状切口、下睑睫毛缘下切口、口内龈颊沟切口入路或上述切口的联合入路。邻近有瘢痕切口时可经瘢痕切口进入，充分显露各个骨折部位。将眶颧骨折断端暴露，在眶内骨膜下剥离，将嵌入的软组织充分游离并回纳至眶内，充分显露眶骨各壁的骨折缺损，对于明显骨折移位骨断端间有软组织嵌钝者，或伤后时间较短，断端间未发生完全骨性愈合者，可用骨凿沿原骨折线处凿断，将骨折块游离复位。对于已发生骨性愈合者，根据设计的截骨线截骨，将整个骨折块完全游离。骨折复位后微型钛板坚强内固定眶下缘及眶外缘的骨折断端。, http://www.100md.com(吴国平 何小川 滕 利 郭 力 李越钢 廖 毅 熊爱兵)
[关键词]眶颧骨折；眼球内陷；手术治疗
[中图分类号]R622 [文献标识码]A [文章编号]1008-6455(2009)02-0166-03
The treatment of late orbitozygomatic fracture with enophthalmos
WU Guo-ping,HE Xiao-chuan,TENG Li, GUO Li, LI Yue-gang, LIAO Yi, XIONG Ai-bing
(Department of Plastic and Burn Surgery,the Affilated Hospital of Luzhou Medical College,Luzhou 646000, Sichuan,China)
Abstract：ObjectiveTo study the surgical treatment of enophthalmos deformity caused by orbitozygomatic fractures.MethodsX-ray, A coronal and an axial computed tomography scan of the orbit, and three-dimensional CT reconstruction were employed todemonstrate the status of the orbitozygomatic fracture andthe displacement andherniated orbital contents of the patients preoperatively. Following exposed the fractured area, the displaced orbital bones were repositioned after osteotomy and rigid fixed by micro-plate and screws to reconstruct the orbital rim. Then the fractured orbital walls were repaired precisely with autogenous bone and biomaterialwhich were fixed to the area beneath the periosteum.ResultsAll patients had their enophthalmos deformity corrected and regained satisfactory zygomaticofacial appearance with this technique. The movement of the globe recovered well, postoperative CT scan demonstrating orbital walls were reconstructed well, the location and formation of medial and inferior rectus muscle were normal, and there was no optic nerve compressed.Conclusions The late orbitozygomatic fracture with enophthalmos deformity can be corrected or obviously improved by the reduction of displaced bone fragments and precise reconstruction the orbital walls with autogenous bone and biomaterial.
Key words: orbitozygomatic fracture; endophthalmos; surgical procedures
颧骨与眶骨及上颌骨的解剖毗邻关系密切，颧骨骨折特别是由高速直接暴力所致，势必导致邻近骨的骨折。眶颧骨折造成眶壁破坏、眶周骨移位塌陷、眶内容物疝出或丢失。因各种原因早期未得到及时复位固定或治疗不当，当肿胀消退后，由于骨折段的畸形愈合、吸收、瘢痕挛缩牵拉，造成后期眶颧骨以及邻近器官和软组织结构的畸形。而眶颧骨折所致后期眼球内陷一直被认为是该区域创伤后畸形矫正的重点和难点。笔者2004年7月～2008年7月收治颧眶骨折伴眼球内陷27例，采用颅颌面外科技术进行矫正，取得良好效果。
1资料和方法
1.1 一般资料：2004年7月至2008年7月收治颧眶骨折伴眼球内陷27例，男18例，女9例，年龄17～61岁，平均34岁。左侧14例，右侧13例，致伤原因：交通事故伤21例，工伤事故者5例，跌落伤者1例。颧骨颧弓骨折9 例；上颌骨合并颧骨颧弓骨折15例。额眶颧骨折3例。受伤后手术时间：3月～17年。术前主要症状体征：颧部塌陷畸形，眼球内陷，眶下区感觉麻木，其中眼球活动受限者8例，复视者12例，视力下降14例。
1.2 术前检查：术前常规行头颅华氏位及眶骨断层X线检查，以了解构成眶缘骨骼的骨折移位情况及有无眶内容物疝入上颌窦，并初步确定各眶壁的骨折情况。为准确诊断各眶壁的骨折情况，进一步做眶骨轴面及冠状位扫描，确定创伤眶骨的所有畸形，包括不同程度的眶壁缺损，软组织疝入上颌窦，嵌入眶外侧壁，眶内侧壁等眶壁的骨折以及眶内软组织移位于邻近解剖间隙的情况。三维CT重建可准确直观显示眶骨的骨折移位情况，为骨折块的复位及眶骨的修复重建提供参考。
1.3 手术方法:所有患者均在全麻下进行手术。根据拟显露部位及手术需要，分别采用头皮冠状切口、下睑睫毛缘下切口、口内龈颊沟切口入路或上述切口的联合入路。邻近有瘢痕切口时可经瘢痕切口进入，充分显露各个骨折部位。将眶颧骨折断端暴露，在眶内骨膜下剥离，将嵌入的软组织充分游离并回纳至眶内，充分显露眶骨各壁的骨折缺损，对于明显骨折移位骨断端间有软组织嵌钝者，或伤后时间较短，断端间未发生完全骨性愈合者，可用骨凿沿原骨折线处凿断，将骨折块游离复位。对于已发生骨性愈合者，根据设计的截骨线截骨，将整个骨折块完全游离。骨折复位后微型钛板坚强内固定眶下缘及眶外缘的骨折断端。, http://www.100md.com(吴国平 何小川 滕 利 郭 力 李越钢 廖 毅 熊爱兵)