Otori Nobuyoshi, Haruna Shinichi, Moriyama Hiroshi
Department of Otorhinolaryngology, Jikei University Hospital, Tokyo, Japan.
Acta Otolaryngol. 2003 Aug;123(6):718-23. doi: 10.1080/00016480310000584a.
Endoscopic repairs of orbital floor fractures performed in our department were reviewed and postoperative outcomes were assessed.
The subjects comprised 88 patients who underwent surgery between 1991 and 2001, 14 of whom had trapdoor fractures. Endoscopic repair was performed when diplopia did not improve after 1 week of conservative treatment. Fractures were repaired via endonasal or transmaxillary routes and fixed with a urinary bladder catheter.
The postoperative course was evaluated on the basis of change in diplopia. After surgery, diplopia resolved in 79.5% of patients but remained, especially on upward gaze, in 20.5% of patients. Residual diplopia was more common in patients with trapdoor fracture.
Endoscopic endonasal and transmaxillary repairs were effective and less invasive methods for freeing orbital tissues trapped by fragments of fractured bone and for restoring smooth ocular movements. However, suspected trapdoor fractures should be repaired within 1 week after injury in order to prevent fibrosis from developing in orbital tissues owing to entrapment by bone fragments.
回顾在我科进行的眶底骨折内镜修复手术，并评估术后效果。
研究对象包括1991年至2001年间接受手术的88例患者，其中14例为活板门骨折。保守治疗1周后复视无改善时进行内镜修复。骨折通过鼻内或经上颌途径修复，并用导尿管固定。
根据复视变化评估术后病程。术后，79.5%的患者复视消失，但20.5%的患者复视仍然存在，尤其是向上注视时。活板门骨折患者残留复视更为常见。
内镜鼻内和经上颌修复是有效且侵入性较小的方法，可松解被骨折碎片困住的眶组织，并恢复眼球平滑运动。然而，疑似活板门骨折应在受伤后1周内进行修复，以防止眶组织因骨碎片嵌顿而发生纤维化。
