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目的探讨鼻眶筛骨骨折后内眦畸形的手术方法及其疗效。方法回顾性分析1999年1月至2004年1月上海交通大学医学院附属第九人民医院眼科诊治的83例(83只眼)单侧鼻眶筛骨骨折后内眦畸形患者行内眦韧带固定和畸形矫正术的临床资料和随访结果。依据内眦移位眼睑畸形的不同和皮肤的瘢痕情况,而分别选择“Y-V”成形、“Z”改形、“Mustard”法及旋转皮瓣矫正内眦皮肤和软组织异常;根据鼻眶筛骨骨折后“中心骨段”骨折或移位的情况,选择缝合固定、钛钉固定、钻孔固定及中心骨段复位钛板固定方法行内眦韧带固定术;对伴有泪道阻塞患者,泪道手术与内眦畸形矫正术同期进行;对伴有眼球移位或鼻梁塌陷患者,先行眼眶重建和隆鼻术,二期行内眦整复手术。83例患者术后随访12-30个月。结果72例患者术后内眦点水平和垂直位置与健侧基本对称,水平和垂直向移位均≤1 mm,内眦凹陷恢复,外观满意。但是11例患者术后6个月内出现内眦移位的复发,其中6例患者再次施行内眦韧带固定和内眦成形手术,术后畸形改善,再无复发移位。结论根据鼻眶筛骨骨折情况和内眦移位严重程度,选择不同的内眦韧带固定方法和内眦成形术,矫正内眦畸形效果显著,疗效稳定。
Objective To investigate the surgical treatment of internal orbital deformity after naso-orbital ethmoidal fracture and its curative effect. Methods A retrospective analysis of 83 cases (83 eyes) of unilateral nasal orbital ethmoidectomy in the Department of Ophthalmology, Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 1999 to January 2004 was performed. Deformity surgery clinical data and follow-up results. According to the internal eyelid shift eyelid deformity and skin scarring, and were selected “YV” shape, “Z” shape, “Mustard” method and rotating flap to correct the internal friction skin and soft tissue abnormalities; After the fracture of the “central segment” fracture or displacement of the situation, select the suture fixation, titanium nail fixation, drilling fixation and central bone reduction plate fixation of the ligament fixation; lacrimal duct obstruction patients, lacrimal duct Surgery and internal deformity correction over the same period; associated with eyeball shift or collapse of the nasal bridge, orbital reconstruction and rhinoplasty, the second line of internal fixation surgery. 83 patients were followed up for 12-30 months. Results In 72 cases, the horizontal and vertical positions of the medial midline were basically symmetrical with the contralateral side, both horizontal and vertical displacements were less than or equal to 1 mm, and the internal ridges and valleys were recovered with satisfactory appearance. However, within 11 months after operation, recurrence of internal transposition occurred in 6 patients. Six patients underwent reoperation of the internal ligament and internal fixation. The postoperative deformity was improved and no recurrence was found. Conclusion According to the situation of nasion orbital ethmoid fracture and the severity of internal 眦 shift, we choose different methods of internal ligament fixation and internal 眦plasty to correct internal 眦 deformity. The curative effect is stable.