Li Teng, Min Ren, Lai Gui
Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, 100041, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2005 Jul;19(7):548-50.
To study the surgical reconstruction for correction of enophthalmos deformity caused by orbital blow-out fractures.
From December 1996 to March 2004, 56 cases of enophthalmos deformity caused by orbital blow-out fracture were repaired. There were 37 cases diplopia, 35 cases with worsened visual acuity than pre-trauma. Typical sub-ciliary incision was employed to expose the fractured area. The dissection was done beneath the medial and inferior orbital periosteum. The fracture areas were exposed and the tissues protrusion to maxillary sinus were released through the space between fractured bones. After the medial and inferior orbital walls and orbital floors were exposed,the herniated orbital contents were released and reduced to the orbital cavity. The fractured orbital walls were repaired precisely with Medpor which were fixed to the area beneath the periosteum with 2 plates at least.
All 56 cases of enophthalmos deformity caused by orbital blow-out fracture repaired with this technique recovered well and their facial appearance improved greatly. With a follow-up ranged from 2 months to 5 years, the degree of enophthalmos stabilized at within 2 mm, no relapse and other complications occurred. Of 34 patients with diplopia, 27 were improved. Of the 35 cases with worsened visual acuity, 9 were improved with different degree. No diplopia or visual acuity worsening occurred.
It is safe and effective to correct the orbital blow-out fractures. The earlier it is repaired, the better the effect will be. Medpor with its advantages like better histocompatibility, easier sculpturing, moderate hardness, lower absorptivity, fewer complications and permanence effect is the preferable implantation material for correcting enophthalmos deformity.
探讨手术重建矫正眼眶爆裂性骨折所致眼球内陷畸形的方法。
1996年12月至2004年3月,对56例眼眶爆裂性骨折所致眼球内陷畸形患者进行修复。其中37例伴有复视,35例视力较伤前下降。采用经典的下睑缘切口暴露骨折区域,在眶内侧和眶下骨膜下进行分离,暴露骨折区域,经骨折间隙将突入上颌窦的组织松解。暴露眶内侧壁、眶下壁及眶底后,将疝出的眶内容物松解并回纳至眶腔。用Medpor精确修复骨折的眶壁,至少用2块钛板固定于骨膜下区域。
56例眼眶爆裂性骨折所致眼球内陷畸形患者采用该技术修复后恢复良好,面部外观明显改善。随访2个月至5年,眼球内陷程度稳定在2mm以内,无复发及其他并发症发生。34例复视患者中,27例复视改善。35例视力下降患者中,9例视力有不同程度改善,无复视及视力下降加重情况发生。
眼眶爆裂性骨折矫正手术安全有效,手术时机越早效果越好。Medpor组织相容性好、塑形方便、硬度适中、吸收率低、并发症少、效果持久,是矫正眼球内陷畸形较理想的植入材料。