以碘仿纱条为支撑材料经鼻内镜鼻窦入路治疗成人眶爆裂性骨折疗效观察

Treatment of adult orbital blowout fracture with iodoform gauze as support material through transnasal endoscopic approach

关键词:  眼眶骨折  鼻内镜手术  外科治疗

Key words:  orbital fracture  endoscopic surgery  surgical treatment

摘要:

目的 探讨以碘仿纱条为支撑材料经鼻内镜鼻窦入路治疗成人眶爆裂性骨折的临床疗效。方法 76例保守治疗无效的眼眶爆裂性骨折患者，其中男57例，女19例，年龄18~57岁，平均38.1岁。拳击伤44例，车祸伤17例，摔伤8例，外物砸伤7例。左侧伤63例，右侧伤13例。眶下壁骨折49例，眶下壁合并眶内壁骨折16例，眶内侧壁骨折11例。合并鼻骨骨折17例，上颌骨额突骨折9例，鼻中隔骨折5例，上颌窦骨折5例，颧骨骨折3例，肋骨骨折2例，鼻中隔血肿2例。均伴有不同程度复视及眼球内陷（两眼相差最小2 mm，最大达6 mm），26例出现视力下降。经鼻内镜鼻窦入路治疗眶内壁和（或）眶下壁骨折，以碘仿纱条作为支撑材料填塞3周。术后3个月观察患者复视状态、视力情况，双眼球突出度以及是否伴有眶内及颅内并发症等。结果 随访3~51个月，平均11.7个月。术后3个月时评估疗效，眼球凹陷恢复满意（双眼球突出度相差均稳定在2 mm以内）。71例复视完全消失，4例第1眼位无复视，向上注视时有部分复视，对患者生活影响有限，患者接受；1例患者术后复视恢复不满意。伤后视力下降患者术后视力均恢复伤前水平。未发生眶内及颅内并发症。结论 经鼻内镜鼻窦入路眶下壁和（或）眶内侧壁骨折整复术视野开阔，钝性复位眶内容，避免眶内结构的新创伤。碘仿纱条经济、长度调节便利、支撑确切、有效预防感染，且为非永久性留置，避免了长期植入材料可能出现的各种并发症。

Abstract:

Objective To explore the clinical effect of iodoform gauze as support material in the treatment of adult orbital blowout fracture through transnasal endoscopic approach. Methods Seventy-six patients with orbital blowout fracture, who failed conservative treatment, were enrolled in the study including 57 males and 19 females. The patients were aged from 18 to 57 years with an average age of 38.1 years. There were 44 cases of boxing injury, 17 cases of car accident injury, 8 cases of fall injury and 7 cases of foreign objects injury. The injuries occurred at the left side in 63 cases and at the right side in 13 cases. There were 49 cases of fracture in inferior orbital wall, 16 cases in both inferior and medial orbital wall and 11 cases in medial orbital wall. There were 17 cases of nasal bone fracture, 9 cases of maxillary frontal process fracture, 5 cases of nasal septum fracture, 5 cases of maxillary sinus fracture, 3 cases of zygomatic fracture, 2 cases of rib fracture and 2 cases of septal hematoma. Different degrees of diplopia and enophthalmos (the difference between the two eyes was at least 2 mm, and the maximum was up to 6 mm), and visual acuity decrease occurred in 26 patients. Transnasal endoscopic approach was used to treat orbital wall fractures, and iodoform gauze was used as the supporting material for 3 weeks. Three months after the operation, the patients' diplopia status, visual acuity, double eyeball protrusion and intraorbital and intracranial complications were observed. Results The patients were followed up for 3-51 months, with an average of 11.7 months. The effect was evaluated 3 months after the operation, and the eye sag recovered satisfactorily (the difference between the two eyeball protrusions was stable within 2 mm). Diplopia completely disappeared in 71 patients. Four patents had no diplopia in the primary eye position and partial diplopia in the upward fixation, which had limited influence on the patients' life and was accepted. The recovery of postoperative diplopia in 1 patient was not satisfactory. The visual acuity in patients with post-injury visual acuity decline was restored to the pre-injury level. No intraorbital or intracranial complications occurred. Conclusion Transnasal endoscopic approach for the treatment of fractures of the inferior orbital wall and/or medial orbital wall opens up the surgical field, enabling blunt reduction of orbital contents to avoid new injuries to orbital structures. Iodoform gauze is economical, convenient in length adjustment, accurate in support, and effective in preventing infection. In addition, it is not permanently indwelled, avoiding various complications that may occur in long-term implant materials.