摘要
目的探讨眶内壁爆裂性骨折患者眼外肌损伤性质等临床特征与骨折形态学特点的相关性。方法根据眶内壁爆裂性骨折的部位和形态学特点,对82例单纯眶内壁骨折进行CT亚型分类:Ⅰ型:整个筛骨纸板粉碎性骨折,筛窦为眶内软组织所填充,内直肌向内明显弯曲、移位;Ⅱ型:筛骨纸板局部骨折,筛窦基本完整,骨折片与眶壁之间形成夹角,内直肌周围软组织嵌顿于骨折区。观察两亚型间患者的眼外肌功能变化特点和相关临床特征。结果Ⅰ型眶内壁骨折的骨折位置偏后、面积较大,眼肌功能损伤性质以内直肌麻痹为主(14/20);Ⅱ型眶内壁骨折的位置偏前,面积较小,眼肌功能损伤以内直肌运动受限为多见(27/38)。Ⅰ型眶内壁骨折患者眼球内陷发生率及内陷程度均明显高于Ⅱ型眶内壁骨折(Z=-6.075,P<0.05;t=3.365,P<0.05)。而复视发生率明显低于Ⅱ型眶内壁骨折(Z=-2.187,P<0.05)。结论眶内壁骨折患者眼外肌功能损伤改变等临床特征与骨折的形态学特点有关;眶内壁骨折CT影像学亚型分类具有临床实用价值。
Objective To observe the extraocular muscle function related changes in medial orbital wall blow-out fracture and the correlations with fracture morphology changes. Methods A subtype criteria was proposed according to the character and locations of the CT images of 82 medial wall blow-out orbital fracture patients. The type 1 has the features of depression of large space of ethmoid sinus with large area fractures of lamina papyracea and filled with orbital soft tissues. The medial rectus muscle could be moved toward medial side. The type 2 could be classified with following features： local fracture of Papyracea with almost complete ethmoid sinus space. The fractured site showed a angle with incarceration of medial rectus muscle and/or the surrounding tissues. The eharacteristic extraocular muscle functions and related clinical manifestations were studied and compared between the two subtypes. Results Type 1 medial orbital wall fractures were in most cases （14/20） located far posteriorly with relatively large fractured area with typical medial rectus muscle palsy clinical presentation.Type 2 fractures were located more anteriorly with relatively small fracture area and present mostly （27/38） with medial rectus muscle movement restriction phenomenon. The incidence and severity of enophthalmos in type 1 was higher and more severer （Z = -6. 075, P 〈0.05;t =3. 365, P 〈0.05） than that in type 2 butt with less patient ofdiplopia （ Z = - 2. 187, P 〈 0. 05 ）, Conclusions The extraocular muscle function alterations and related clinical characteristics in medial orbital wall blow-ont fracture patients were closely related with the location and morphological changes of the fractures presented in CT images. The proposed subtyping criteria should have valuable clinical application for evaluation of extraoclar muscle function and other related clinical parameters in orbital fracture patients.
出处
《眼外伤职业眼病杂志》
北大核心
2007年第4期249-252,共4页
Journal of Injuries and Occupational Diseases of the Eye with Ophthalmic Surgeries
关键词
眼眶爆裂性骨折
眶内壁
眼外肌
复视
眼球内陷
orbital blow-ont fracture
medial orbital wall
extraocular muscle
diaplopia
enophthalmos
