Clinical Analysis Of Surgical Treatment Of Orbital Blowout Fracture

Objective:To evaluate the clinical effect of surgical treatment in orbital blowout fracture.Methods:We selectsd83patients with orbital blowout fracture, who underwent surgical operation in the Affiliated Hospital of Chinese People’s Armed Police Forces Logistics Institute between January,2008and June,2011. These patients came to our hospital within2hours to4days after injury, computed tomography examination showed the broken media wall and/or inferior wall of orbit and expansion of the orbital cavity. Magnetic resonance imaging examination found that part of orbital contents transposed into the adjacent paranasal sinus cavity, extraocular muscles inserted into the fracture defect site and were thicked. After7-10days treatment of elimination and neurotrophic symptomatic, the eye enophthalmos was clearly identified by using Hertel suddenprominent. Diplopia and eye movement disorders were determined by nine diagnostic eye position. Eyeball rupture, traumatic brain injury, thoracic and abdominal injury were excluded by physical examination.10-14days after injure, the patients, under local anesthesia combined with strengthening the anesthesia, were operated by orbital blowout fracture reconstructive surgery and Medpor implantation from the lower eyelid skin approach. The displacement of orbital soft tissue was corrected. By using Medpor as the filler for orbital fracture repair, eye position was restored, enophthalmos corrected, and the eye movement disorder and diplopia alleviated. Patients were followed up6months:postoperative indicators of eyeball movement, enophthalmos, vision acuity, dipolopia and infraorbita nerve feeling were compared with the preoperative indicators.Results:For69of the total83patients, accounting for83.13%, their visual acuity were improved after operation;14patients, accounting for16.87%, showed no improvement immediately after the operation, whose corrected visual acuity, however reached0.8after neurotrophictherapy; all the eyes before surgical operation was more than2mm deeper than the healthy ones. After operation,78cases, accounting for93.98%, reported satisfactory enophthalmos correction,5cases, accounting for6.02%, with unsatisfactory correction.79cases, accounting for95.18%, showed normal eye movement,4cases, accounting for4.82%, with unsatisfactory correction;75cases, accounting for90.36%, reported diplopia eliminating,8cases, accounting for9.64%, with unsatisfactory correction. All the eyes were not infraorbital neural sensory loss; postoperative incisions were well healed, eyelid soft tissue swelling and subcutaneous bleeding of7to13days dissipated; there was no report of infection, implant extrusion and displacement.Conclusion:Orbital blowout fracture line orbital prosthesis coronal and horizontal spiral CT scan, combined with MRI examination can determine the fracture extent, scope and quantity of fill material needed, intraoperative use of porous high density polyethylene surgical implant can effectively repair orbital fractures defects, correct enophthalmos satisfaction, effective solve the problem of the orbital soft tissue embedded folder and eye movement disorders, improve diplopia, it also shows ideal with histocompatibility, no obvious implant surgery rejection.