眶底爆裂性骨折致眼球运动障碍的上颌窦手术进路治疗

目的 观察上颌窦进路手术治疗眶下壁爆裂性骨折所致眼球运动障碍的临床效果.方法 对12例12只眼眶下壁爆裂性骨折伴复视及眼球运动障碍者,眼眶CT显示:眼外肌眶内软组织嵌顿于眶下壁骨折区,伤后观察2周,复视及眼球运动障碍无明显改善,采用上颌窦进路行眶下壁骨折复位术.术后随诊3～6个月.结果 12例患者术中开放上颌窦后可清晰观察到眶下壁骨折区各个边界及眶内软组织嵌顿情况,术中均将嵌顿在眶底骨折处的眶内组织推送回眶内,眶底骨折复位.术后12例患者中10例各方向眼球运动不受限,无复视,2例正前方及下方无复视,向上方运动轻度受限.术后1例并发上颌窦炎,经上颌窦冲洗治愈.结论 上颌窦进路早期治疗单纯眶下壁爆裂性骨折所致眼球运动障碍是有效的.     

儿童眶壁爆裂性骨折的临床分析

目的分析儿童眶壁爆裂性骨折的特点，寻求有效的治疗措施。设计回顾性病例系列研究。研究对象12岁以下儿童眶壁爆裂性骨折患者59例（59眼）。方法观察患儿眼位、眼球内陷程度、眼球运动、复视情况，通过眼眶CT观察骨折位置、大小、肌肉嵌顿情况等。59眼中牵拉治疗5眼，行眶壁骨折整复术治疗54眼。主要指标骨折位置，眼位，眼球内陷程度，眼球运动，复视情况。结果59例患者治疗前均有复视，眼球运动受限，1例眼球轻微内陷。59例眼眶CT均显示眶壁骨折，其中眶底骨折57例，眶内壁骨折2例，眶底与眶内壁均骨折1例。牵拉治疗1-3次5例患者复视消失。整复手术治疗者于术后8个月内复视消失，伤后1周内手术者，术后1个月内复视消失。结论儿童眶壁骨折多发生于眶底，眼球内陷少且轻微。重度眼球运动障碍，有直肌嵌塞者，应及早手术；手术越早（〈1周），复视消失越迅速。牵拉治疗对儿童某些轻型骨折有效。     

三维眶底重建钛网在复合性眼眶骨折中的应用

目的 探讨应用三维眶底重建钛网治疗复合性眼眶骨折修复眶底缺损的手术方法和临床效果.方法 回顾性系列病例研究.回顾性分析13例(13只眼)行三维眶底重建钛网植入眼眶骨折修复眶底重建手术的复合性眼眶骨折患者的临床资料.其中眶颧颌骨折6例,鼻眶筛骨折5例,眼眶四壁多发性骨折2例.术中联合行颧骨、上颌骨骨折、鼻骨以及额骨骨折修复,8例眼球重度凹陷的患者同时行高密度聚乙烯眶内充填.手术前后测量眼球突出度、眼球运动以及眼眶CT扫描(水平位、冠状位以及三维重建).术后随访3～6个月.结果 术前患眼眼球凹陷平均(3.9±1.7)mm,眼球下移(3.1±2.6)mm.13例患者中,12例存在眼球运动障碍,其中Ⅰ级有4例,Ⅱ级有7例,Ⅲ级有2例.术后除3例患者残存眼球凹陷1.0 mm,其余10例患者眼球凹陷矫正;8例患者眼球下移完全矫正,3例残留眼球下移1.0 mm,2例患者眼球上移1.0 mm;术后3个月后8例患者眼球运动受限完全矫正,其余5例眼球运动障碍减轻,其中残留Ⅱ级运动障碍2例,Ⅰ级运动障碍3例;随访过程中未发现三维眶底重建钛网移位、排斥、感染及其他不良反应.结论 三维眶底重建钛网具有良好的生物相容性,采用三维眶底重建钛网治疗复合性眼眶骨折,可有效恢复眼眶容积,矫正眼球内陷和下移,改善眼球运动.

Abstract：

Objective To evaluate the outcomes of the clinical application of three-dimensionally preformed titanium mesh plates for posttraumatic complex orbital bone fracture reconstruction. Methods Thirteen patients (13 eyes) manifested with complex orbital fractures (including orbital-zygomatic- maxillary bone fracture in 6 patients,nasal-orbital-ethmoid bone fracture in 5 patients and complex multiple periorbital bone fracture in other 2 patients ) underwent the reconstructive surgery by using three-dimensionally preformed titanium mesh plates. Eight cases underwent high density porous polyethylene implantation simultaneously. Evaluation of enophthalmos,eyeball movement,and orbit CT scan were taken pre- and post-operatively. Results The average enophthalmos was (3.9 ± 1.7 ) mm and the position of the affected eyeball was( 3. 1 ± 2. 6)mm bellow the contralateral side preoperatively. Twelve patients suffered from eyeball movement restriction,including grade Ⅰ in 4 cases,grade Ⅱ in 7 cases and grade Ⅲ in 2 cases. During the 3 to 6 months post operative follow-up,enophthalmos was completely corrected in 10 patients while the other 3 patients had residual 1.0 mm enophthalmos. The affected eyeballs were repositioned in 8 cases and 3 cases had residual 1 mm lower position and 2 cases with a 1 mm higher positioned eyeball. Eye movement was not restricted in 8 patients,whereas 3 patients had grade Ⅰ movement restriction and 2 patients had grade Ⅱ movement restriction. There were no rejection,infection and other complications during follow-up.Conclusions Three-dimensionally preformed titanium mesh plates can be used to reconstruct posttraumatic complex orbital bone fractures in order to improve the orbital volume and to correct enophthalmos effectively.     

眼眶爆裂性骨折复视的早期治疗

目的观察眼眶爆裂性骨折后复视及眼球运动障碍早期治疗的临床效果。方法对24例（24跟）眼眶爆裂性骨折致复视及眼球运动障碍行早期保守及手术治疗。其中单纯内侧壁骨折6例,单纯眶底骨折15例,内侧壁合并眶底骨折3例。8例行保守治疗,J6例行手术治疗：结果8例保守1冶疗者复视及限球运动障碍全部治愈。16例手术治疗者中,复视4例治愈,12例好转;16例眼球运动障碍全部好转结论对于眼眶爆裂性骨折后复视及眼球运动障碍,正确诊断及早期治疗对患者眼部功能恢复及外形改善非常重要。     

眼眶爆裂性骨折的手术治疗

目的:探讨眼眶爆裂性骨折的手术治疗方法和效果。方法:对24例眼眶爆裂性骨折患者进行复位手术,将嵌顿眶内容物复位,以钛板钛钉铆合或植入Medpor植片修补骨折缺损区,术后观察患者眼眶外观、眼球运动、视力、复视等情况。结果:术后眼球内陷改善、眼球运动改善、视力良好、复视基本消失。结论:眼眶爆裂性骨折致复视、眼球运动障碍等及时手术可获得良好眼位及视功能。     

爆裂性眶壁骨折早期治疗的意义

目的分析爆裂性眶壁骨折的早期治疗效果。方法对125例爆裂性眶壁骨折就诊情况做了详细的分析,并对其发病原因、临床表现和发病机制进行详细的描述。结果在125例爆裂性眶壁骨折中出现复视及眼球运动障碍者91例,其中74例首诊于眼科考虑爆裂性眶壁骨折,均接受及时治疗,病情得到缓解,挽救了视力;另17例因合并其他部位外伤,首诊其他科室,出现复视及眼球运动障碍后按眼外肌麻痹进行对症治疗,效果不佳。结论眼眶爆裂性骨折在抢救中易被忽视而误诊,提高眼科医生对复合伤的认识和非眼科医生对爆裂性眶壁骨折的认识能力,使患者能得到早期诊断和治疗。     

自体阔筋膜修复治疗单纯眼眶下壁爆裂性骨折

目的评价自体阔筋膜修复治疗单纯眼眶下壁爆裂性骨折的效果。方法将21例（21只眼）单纯性眼眶下壁爆裂性骨折患者根据骨折范围分为2组，骨折范围〉2cm^2者9例（9只眼），≤2cm^2者12例（12只眼），行自体阔筋膜修复术，术后随访3～6个月。观察两组术后复视，眼球突出度情况及视力。结果复视完全消失15例（71．43％），眶下壁骨折〉2cm^2者眼球内陷矫正2例（22．2％），≤2cm^2眼球内陷矫正10例（83．3％），视力提高5例（23．8％）。结论应用自体阔筋膜经下睑缘人路治疗单纯眶下壁爆裂性骨折，能有效地恢复眼球运动。修复眶腔，对于损伤≤2cm^2病例效果较好。     

眼眶骨折修复术中并发硬膜外血肿1例

0引言眼眶骨折是由于外部致伤因素作用于眼部,导致眼眶壁骨质破坏,产生眶内出血、眶内容嵌塞、眼位改变、复视、眼球运动障碍、眶腔扩大、眼球内陷、视力下降等症状[1]。常见的手术并发症有术中眶内出血和血肿、神经肌肉损伤、术后植入物排斥脱出、眼球运动障碍,上睑下垂等。合并颅骨骨折时,还可出现脑脊液眶漏及鼻漏等并发症,     

爆裂性眼眶骨折的计算机断层扫描评估及手术

目的探讨爆裂性眼眶骨折的计算机断层扫描（CT）所见及手术治疗方法和效果。方法分析136例（141眼）爆裂性眼眶骨折的临床表现和CT影象,对其中71眼进行复位手术,将嵌顿的眶内容物复位,植入高密度多孔聚乙烯植片或以钛板钛钉铆合的方式修补眼眶骨折缺损,手术后观察眼眶外观、眼球运动、复视的恢复情况。结果由CT影像确定患者中有78眼单纯眼眶内侧壁骨折,18眼单纯眶下壁骨折,36眼双眶壁骨折,9眼混合型骨折。术后眼球内陷的情况明显改善,眼球的运动也灵活很多,复视症状完全消失。结论综合运用眼眶CT横轴位和冠状位扫描,对于显示爆裂性眼眶骨折的影像学征象、决定治疗方案、评估预后都有重要价值。早期手术的效果显著。     

内壁合并下壁眼眶爆裂性骨折Medpor修复

目的 探讨Medpor植入术治疗内壁合并下壁眼眶爆裂性骨折的手术方法及手术效果。方法对确诊为内壁合并下壁眼眶爆裂性骨折12例(12眼)行眼眶整复及骨折区骨膜下Medpor植入术，观察比较术前术后眼球突出度、眼外肌运动、复视及视力等情况。结果术后所有患眼眼球内陷矫正，眼球活动良好，复视消失，手术未影响视力，术后随访期间无植入物脱出或排斥反应。结论有并发症的内壁合并下壁眼眶爆裂性骨折患者应及早行眼眶整复术治疗，应用Medpor作植入物安全有效，是重建眶壁理想的生物材料。     

Electrophysiological determination of the refractive state of the eye of the opossum

The refractive state of the eye of the South American opossum Didelphis marsupialis aurita was investigated with electrophysiological techniques. Using adult specimens, trapped from the wild, averaged cortical evoked responses were recorded from the region of projection of the central visual field. Stimuli consisted of a phase reversal of a square wave grating generated on a CRO screen, with luminance of 2.4 cd/m2 and contrast 0.84. The refractive state of the eye was altered by means of trial lenses and the amplitude of the cortical responses thus obtained compared to those obtained with no lens (control values). Refraction "tuning curves" were determined for each animal. The average refractive state was found to be -2.27 D indicating that this species when raised in its habitat shows, at low ambient luminosity, some degree of myopia. Determination of the Contrast Sensitivity Function indicate that induced ametropias lead to a reduction of the cut-off value of the spatial frequency and a loss of contrast sensitivity.     

Influence of exercise on the structure of the anterior chamber of the eye

Purpose

To measure changes in anterior chamber structure before and after exercise in healthy individuals using anterior segment optical coherence tomography (ASOCT).

Methods

Thirty‐two healthy young individuals performed jogging for 20 min. Eye blinking rate was recorded during rest and exercise. The anterior chamber angle (ACA), angle opening distance at 500 μm from the scleral spur (AOD500), trabecular‐iris space area at 500 μm from the scleral spur (TISA500), iris concavity (IC), iris concavity ratio (CR), iris thickness at 750 μm from the scleral spur (IT750), anterior chamber depth (ACD), anterior chamber width (ACW), pupil diameter (PD), intraocular pressure (IOP), blood pressure (BP) and heart rate (HR) were recorded before and after exercise. Anterior chamber angle (ACA), AOD500, TISA500, IC, IT750, ACD, ACW and PD were measured with ASOCT.

Results

Compared with rest, the blinking rate during exercise did not change significantly (13.04 ± 5.80 versus 13.52 ± 5.87 blinks/min, p = 0.645). The average IOP (15.4 ± 2.4 versus 12.4 ± 2.1 mmHg), ACA (35.96 ± 11.35 versus 40.25 ± 12.64 degrees), AOD500 (0.800 ± 0.348 versus 0.942 ± 0.387 mm), TISA500 (0.308 ± 0.155 versus 0.374 ± 0.193 mm²), IC (?0.078 ± 0.148 versus ?0.153 ± 0.159 mm) and CR (?0.027 ± 0.050 versus ?0.054 ± 0.056) changed significantly (all p < 0.001), while the average IT750 (0.463 ± 0.084 versus 0.465 ± 0.086 mm; p = 0.492), ACD (3.171 ± 0.229 versus 3.175 ± 0.238 mm; p = 0.543) and ACW (11.768 ± 0.377 versus 11.755 ± 0.378 mm; p = 0.122) showed no significant change after exercise.

Conclusion

The blinking rate did not change significantly during exercise, while ACA, AOD500 and TISA500 increased after exercise. Exercise also induced or increased IC. These changes in anterior chamber structure were only associated with exercise, but not with the postexercise change in PD or IOP.