Nunery William R, Tao Jeremiah P, Johl Sukhjit
Oculofacial Plastic and Orbital Surgery, Indianapolis, Indiana, USA.
Ophthalmic Plast Reconstr Surg. 2008 Jul-Aug;24(4):271-5. doi: 10.1097/IOP.0b013e3181788de8.
To evaluate a technique of implanting a single 0.4-mm-thick nylon foil (Supramid) continuously across combined medial wall and floor fractures within weeks of orbital trauma.
This retrospective, interventional case series includes patients with combined medial wall and floor fractures with or without external orbital and facial fractures, without prior surgery, and who were in the early posttrauma phase. One hundred two orbits in 98 consecutive patients were treated with a "wraparound" technique. The surgical technique is provided in detail. Comatose patients, those with cranial nerve palsies, severe globe injury, anophthalmia, or previous repair of the same fractures were excluded. Patients underwent surgery from 5 to 21 days after trauma. Postoperatively (average, 6.2 months), patients were evaluated for enophthalmos, extraocular motility, and diplopia.
In 101 of 102 orbits, normal globe position, and full extraocular motility without diplopia was accomplished. One orbit had persistent enophthalmos, requiring a second procedure. This same patient had ipsilateral restriction in extreme upgaze, but no diplopia symptoms. This orbit had complete loss of inferomedial strut support. Overall, strut loss was not a risk factor for subsequent enophthalmos. No other patient had globe malposition, restrictive myopathy, or diplopia. Implant migration, hemorrhage, fistula, or infection was not observed. The transconjunctival and canthal wounds were hidden and tolerated by all patients with no eyelid cicatrization, webbing, or malposition.
The "wraparound" technique for 0.4-mm nylon foil implantation continuously across orbital floor and medial wall fractures was associated with almost no enophthalmos and diplopia in this series.
评估一种在眼眶外伤后数周内，将单一厚度为0.4毫米的尼龙箔（Supramid）连续植入内侧壁和眶底联合骨折处的技术。
本回顾性、介入性病例系列研究纳入了内侧壁和眶底联合骨折的患者，这些患者有或没有眶外及面部骨折，未接受过先前手术，且处于创伤后早期。连续98例患者的102个眼眶采用了“环绕”技术进行治疗。详细介绍了手术技术。排除昏迷患者、有颅神经麻痹、严重眼球损伤、无眼球症或先前已修复相同骨折的患者。患者在创伤后5至21天接受手术。术后（平均6.2个月），对患者进行眼球内陷、眼球运动和复视评估。
102个眼眶中的101个实现了眼球位置正常、眼球运动完全且无复视。1个眼眶持续存在眼球内陷，需要进行二次手术。该患者同侧极度上视受限，但无复视症状。该眼眶内侧下支柱支撑完全丧失。总体而言，支柱丧失并非后续眼球内陷的危险因素。没有其他患者出现眼球位置异常、限制性肌病或复视。未观察到植入物移位、出血、瘘管或感染。所有患者的结膜下和内眦伤口均不明显且能耐受，无眼睑瘢痕形成、蹼状畸形或位置异常。
在本系列研究中，将0.4毫米尼龙箔连续植入眶底和内侧壁骨折处的“环绕”技术几乎未导致眼球内陷和复视。
