Markowitz B L, Manson P N, Sargent L, Vander Kolk C A, Yaremchuk M, Glassman D, Crawley W A
Division of Plastic Surgery, Maryland Institute of Emergency Medical Services Systems, Baltimore.
Plast Reconstr Surg. 1991 May;87(5):843-53. doi: 10.1097/00006534-199105000-00005.
The medial canthal tendon and the fragment of bone on which it inserts ("central" fragment) are the critical factors in the diagnosis and treatment of nasoethmoid orbital fractures. The status of the tendon, the tendon-bearing bone segment, and the fracture pattern define a clinically useful classification system. Three patterns of fracture are appreciated: type I--single-segment central fragment; type II--comminuted central fragment with fractures remaining external to the medial canthal tendon insertion; and type III--comminuted central fragment with fractures extending into bone bearing the canthal insertion. Injuries are further classified as unilateral and bilateral and by their extension into other anatomic areas. The fracture pattern determines exposure and fixation. Inferior approaches alone are advised for unilateral single-segment injuries that are nondisplaced superiorly. Superior and inferior approaches are required for displaced unilateral single-segment injuries, for bilateral single-segment injuries, and for all comminuted fractures. Complete interfragment wiring of all segments is stabilized by junctional rigid fixation. All comminuted fractures require transnasal wiring of the bones of the medial orbital rim (medial canthal tendon-bearing or "central" bone fragment). If the fracture does not extend through the canthal insertion, the canthus should not be detached to accomplish the reduction.
内眦韧带及其附着的骨碎片（“中央”碎片）是鼻筛眶骨折诊断和治疗的关键因素。韧带的状态、韧带附着的骨段以及骨折类型定义了一个临床上有用的分类系统。可识别出三种骨折类型：I型——单段中央碎片；II型——粉碎性中央碎片，骨折位于内眦韧带附着点外侧；III型——粉碎性中央碎片，骨折延伸至承载眦部附着点的骨内。损伤还可进一步分为单侧和双侧，并根据其向其他解剖区域的延伸情况进行分类。骨折类型决定了手术显露和固定方式。对于向上无移位的单侧单段损伤，建议仅采用下方入路。对于移位的单侧单段损伤、双侧单段损伤以及所有粉碎性骨折，则需要采用上方和下方入路。通过连接部位的坚强固定来稳定所有骨折段的完整片段间钢丝固定。所有粉碎性骨折均需要在内侧眶缘骨（承载内眦韧带的或“中央”骨碎片）上进行经鼻钢丝固定。如果骨折未延伸穿过眦部附着点，则不应分离眦部来完成复位。
