Sun H, Wu P S, Song L Y, Hu J Y, Dong S, Lu W
Department of Ophthalmology, the Second Hospital of Dalian Medical University, Dalian 116023, China.
Zhonghua Yan Ke Za Zhi. 2016 Apr 11;52(4):273-7. doi: 10.3760/cma.j.issn.0412-4081.2016.04.008.
To investigate the clinical outcomes following early repair for orbital fracture and soft tissue simultaneously for open orbital fractures.
Retrospective clinical study. This study comprised of 19 patients(20 eyes) with open orbital fracture who underwent surgery within 48 hours in the Second Hospital of Dalian Medical University between August 2011 and August 2014. The wounds were evaluated at the same time and the surgical debridement was done. The surgical exposure was achieved through direct approach and auxiliary cosmetic incisions. Titanium mesh and plate was used for orbital reconstruction. Local flaps or island flaps were used for soft tissue repair. With the post-operative CT scan, the condition of the soft tissue which was herniated, the orbital rim and orbital wall were observed. The measurement of the exophthalmos of both eyes was performed using Hertel exophthalmometer. Compared with the intact eye, the globe displacement (upward or downward) of the reconstructed eye was measured. The follow up duration was 12-24 months. The eye movement, diplopia, restriction of mouth opening, depression of midface, the condition of soft tissue and scar as well as post-operative complications were recorded. Comparison of the reconstructed eye's globe displacement before and after operation were analyzed with wilcoxon signed ranks test. Comparison of the exophthalmos of the reconstructed eye relative to the intact eye were analyzed with t-paired test.
In all 19 cases (20 eyes), fractures were anatomically reconstructed, and no cases of infection, titanium mesh and plate migration and rejection occured during the follow-up. Seven cases had eyeball hypoglobus with median 3.0 mm (min 2.0 mm, max 4.0 mm) pre-operatively. The Reconstructed eye globe were corrected in 6 cases and 1 case had residual hypoglobus of 1.0 mm ,median 0.0 mm (min 0.0 mm, max 1.0 mm). The amount of the eye globe displacement between pre-and post-operation was statistically significant(z=-2.40, P<0.05). Enophthalmos was corrected in 16 cases (the mean of posterior globe displacement in reconstructed orbit relative to intact orbit was less than or equal to 2.0mm), but in 2 patients the residual enophthalmos was 3.0 mm. The difference of the exophthalmos of both eyes was not obvious (t=-0.46,P>0.05). Among 20 eyes, 16 patients had restrictive eye movement. After 12 months follow-up, 13 eyes with restrictive eye movement were corrected while the other 3 showed improvement. Eight patients of restriction of mouth opening or midface depression were corrected and no infection complications were noted. There was no flap necrosis in 13 patients of soft tissue defect.
Surgical treatment of open orbital fractures with simultaneous repair of orbital fracture and soft tissue within 48 hours after trauma could correct enophthalmos, hypoglobus and eye movement function effectively and improve periorbital aesthetics. (Chin J Ophthalmol, 2016, 52: 273-277).
探讨开放性眼眶骨折早期同时修复眼眶骨折与软组织的临床疗效。
回顾性临床研究。本研究纳入2011年8月至2014年8月期间在大连医科大学附属第二医院48小时内行手术治疗的19例（20眼）开放性眼眶骨折患者。同期对伤口进行评估并进行手术清创。通过直接入路和辅助美容切口实现手术暴露。采用钛网和钛板进行眼眶重建。采用局部皮瓣或岛状皮瓣进行软组织修复。术后通过CT扫描观察疝出软组织、眶缘和眶壁情况。使用Hertel眼球突出计测量双眼眼球突出度。测量重建眼与健眼相比眼球的移位情况（向上或向下）。随访时间为12 - 24个月。记录眼球运动、复视、张口受限、面中部凹陷、软组织及瘢痕情况以及术后并发症。采用Wilcoxon符号秩和检验分析重建眼手术前后眼球移位情况。采用配对t检验分析重建眼与健眼眼球突出度的差异。
19例（20眼）患者骨折均获得解剖复位，随访期间无感染、钛网钛板移位及排斥反应发生。7例患者术前存在眼球内陷，中位数为3.0 mm（最小值2.0 mm，最大值4.0 mm）。6例患者重建眼眼球内陷得到纠正，1例残留1.0 mm内陷，中位数为0.0 mm（最小值0.0 mm，最大值1.0 mm）。手术前后眼球移位量差异有统计学意义（z = -2.40，P < 0.05）。16例患者眼球内陷得到纠正（重建眼眶相对于健侧眼眶后极部眼球移位均值小于或等于2.0 mm），但2例患者残留3.0 mm眼球内陷。双眼眼球突出度差异不明显（t = -0.46，P > 0.05）。20眼中16例患者存在眼球运动受限。随访12个月后，13例眼球运动受限患者得到纠正，另3例有所改善。8例张口受限或面中部凹陷患者得到纠正，未出现感染并发症。13例软组织缺损患者皮瓣无坏死。
外伤后48小时内手术治疗开放性眼眶骨折并同时修复眼眶骨折与软组织，可有效纠正眼球内陷、眼球下移及眼球运动功能，改善眶周美观度。（《中华眼科杂志》，2016，52：273 - 277）
