CAJ | 학술논문

目的探讨眼眶外侧壁击人性骨折的临床特征及手术治疗要点。方法回顾性系列病例研究。分析2007年1月至2010年1月在上海交通大学医学院附属第九人民医院眼科住院诊治的12例眼眶外侧壁击人性骨折患者的临床资料，结合术后复查结果，分析此类型骨折的临床特点及治疗预后。结果 12例眼眶外侧壁击人性骨折病例均表现为颧骨额突楔入眶内，其中1例眼球破裂行一期眼球摘除手术，4例发生外伤性视神经病变。1例表现为眼球突出，8例眼球内陷。复视5例，眼球运动障碍5例。眼部合并损伤有：上睑畸形3例，上睑下垂1例，内眦间距增宽合并泪道损伤3例。合并骨折有：眶底骨折11例，颧弓骨折9例，眶内壁骨折6例，鼻眶筛骨折3例。手术治疗根据损伤范围采用下睑缘睫毛下切口、口内切口、冠状切口、眉下外侧眶缘切口或原有伤口，完全复位骨折片，钛钉钛板固定，多孔聚乙烯或钛网修复合并的眶内壁或底壁骨折，伤后骨折已畸形愈合的病例，采用截骨复位术修复骨折。11例行眶壁整复手术的病例，眶壁骨折均得到准确复位。结论眼眶外侧壁击人性骨折对眼部损伤严重，应提高对此类骨折的认识，及时采取有效的治疗。
목적 탐토안광외측벽격인성골절적림상특정급수술치료요점。방법 회고성계렬병례연구。분석2007년1월지2010년1월재상해교통대학의학원부속제구인민의원안과주원진치적12례안광외측벽격인성골절환자적림상자료，결합술후복사결과，분석차류형골절적림상특점급치료예후。결과 12례안광외측벽격인성골절병례균표현위권골액돌설입광내，기중1례안구파렬행일기안구적제수술，4례발생외상성시신경병변。1례표현위안구돌출，8례안구내함。복시5례，안구운동장애5례。안부합병손상유：상검기형3례，상검하수1례，내자간거증관합병루도손상3례。합병골절유：광저골절11례，권궁골절9례，광내벽골절6례，비광사골절3례。수술치료근거손상범위채용하검연첩모하절구、구내절구、관상절구、미하외측광연절구혹원유상구，완전복위골절편，태정태판고정，다공취을희혹태망수복합병적광내벽혹저벽골절，상후골절이기형유합적병례，채용절골복위술수복골절。11례행광벽정복수술적병례，광벽골절균득도준학복위。결론 안광외측벽격인성골절대안부손상엄중，응제고대차류골절적인식，급시채취유효적치료。
Objective To analyze the clinical features of lateral orbital wall blow-in fracture and summarize the points of treatment. Methods A retrospective analysis of 12 patients with lateral orbital wall blow-in fracture treated in the Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine from January 2007 to January 2010 was investigated. Clinical records and results of follow-up were analyzed. Results Twelve cases of the lateral orbital wall blow-in fracture with the frontal process of the zygoma impacted into the orbit were confirmed. Globe rupture occurred in 1 case,4 cases had traumatic optic neuropathy. 1 case suffered exophthalmos, 8 cases had enophthalmos. Diplopia was found in 5 cases and eyeball movement disturbance in 5 cases. 3 cases had upper eyelid deformity,1 case had ptosis, 3 cases had telecanthus accompanied with lacrimal ducts obstruction. 11 cases suffered orbital floor fracture, 9 cases had zygomatic arc fracture, 6 cases had orbital medial wall fracture, and 3 cases had naso-orbito-ethmoid fracture. Surgical treatnent was performed by different combination of approaches according to the extents of injury; Osteotomy was performed in patients whose blow-in fracture was malformation. Orbital reconstructive surgery was performed in 11 patients and fractures were completely restored. Conclusions The Iateral orbital wall blow-in fracture could cause serious impairment to the ocular components, better outcomes could be achieved by timely and proper treatment with improving recognition of this type of fracture.