眶-上颌-颧骨复合骨折临床分类治疗探讨

目的:探讨眶-上颌-颧骨(OMZ)复合骨折三维立体结构上的分类法,以提高临床治疗水平。方法:收集69例OMZ骨折病例,通过常规X线片、螺旋CT片检查,从三维立体结构角度将骨折分为四型,总结临床治疗方法及效果。结果:术后随访2个月～4年,69例患者颧面部塌陷畸形均得到良好改善,咬合关系紊乱的患者均达到功能性咬合,通过训练后,张口度恢复满意,无面神经永久性损伤。A型骨折12例,无不良症状发生。B型骨折15例,有1例术后颧-眶外壁处仍稍显膨隆。C型骨折32例,有3例术后眶下神经麻痹症状未能恢复。D型骨折10例,术后眼球内陷1例,仍>2mm,复视未能恢复1例,眶下神经麻痹症状未恢复3例,术后切口感染1例,术后颧骨颧弓仍稍显膨隆3例。结论:眶-上颌-颧骨复合骨折四型分类法,对指导临床治疗有一定参考价值。

Classification and Treatment of Orbital-Maxillary-Zygomatic (OMZ) Complex Fractures

Objective:To discuss the clinical applications of the classification of orbital-maxillary-zygomatic(OMZ) complex fractures by three-dimensional representation,and to improve clinical treatment.Methods:69 cases with OMZ complex fractures were reviewed.OMZ complex fractures can be subdivided into A,B,C,D subtypes through spiral CT examination and three-dimensional reconstruction examination.Results:Follow-up period lasted from 2 months to 4 years. All patients'zygomatic depression deformities were corrected and improved.The malocclusion was harmonized.Mouth open became normal after training.There were no long-term facial nerves paralysis.In 12 cases of A subtype OMZ fractures,none had any complications.In 15 B subtype cases,only one zygomatic-orbital external wall swelling.In 32 C subtype cases,3 had long-term paralysis of sub-orbital nerves.In 10 D subtype OMZ fractures cases,one showed an eye- ball invagination(>2 cm)and one diplopia.Conclusion:Four subtype classification of orbital-maxillary-zygomatic(OMZ) complex fractures may have some value in clinical application.