探讨不同方案治疗眼球萎缩合并眶壁骨折的临床效果。

收集2017年1月至2020年12月于首都医科大学附属北京同仁医院眼科中心眼球萎缩合并眶壁骨折患者47例(47只眼)的临床资料。其中，男性39例(39只眼)，女性8例(8只眼)；年龄18~68岁，平均年龄(39.3±11.8)岁。根据规则采取不同方案进行手术治疗。记录患者的手术方案、病变类型、植入材料、植入义眼台的直径及佩戴义眼片的情况，以例数(眼数)和百分比进行描述；测量并计算术后6个月时患者双侧眼球突出度差值，以中位数和四分位数间距[M(P25，P75)]表示；问询患者对术后外观的满意度，记录患者的随访时间和并发症的发生情况，以例数(眼数)和百分比进行描述。

全部患者47例(47只眼)佩戴义眼片后均可调整至两侧眼球突出度差值<2 mm，至随访结束，均对外观满意。其中，合并单纯眶内壁骨折无眶壁骨折修复仅植入义眼台者19例(19只眼)，占40.43%；术后6个月时两侧眼球突出度差值为2~4 mm，中位数为3(2，3)mm。合并单纯眶下壁骨折无眶壁骨折修复仅植入义眼台者15例(15只眼)，占31.92%；术后6个月，两侧眼球突出度差值为3~5 mm，中位数为4(3，4)mm。合并单纯眶下壁骨折行眶壁骨折修复且植入义眼台者2例(2只眼)，占4.26%；术后6个月时两侧眼球突出度差值均为3 mm。合并眼眶内壁及下壁骨折无眶壁骨折修复仅植入义眼台者7例(7只眼)，占14.89%；术后6个月时两侧眼球突出度差值为4~5 mm，中位数为4(4，5)mm。合并眼眶内壁及下壁骨折仅行眶下壁骨折修复且植入义眼台者3例(3只眼)，占6.38%；术后6个月时两侧眼球突出度差值为2~4 mm，中位数为3(2，4)mm。合并眼眶内壁及下壁骨折行眶内壁及下壁联合修复且植入义眼台者1例(1只眼)，占2.13%；术后6个月时两侧眼球突出度差值为4 mm。全部患者47例(47只眼)中，植入23 mm直径义眼台者共8例(8只眼)，占17.02%；术后6个月时两侧眼球突出度差值为3~5 mm，中位数为3.5(3，4)mm。植入24 mm直径义眼台者39例(39只眼)，占82.98%；术后6个月时两侧眼球突出度差值为2~5 mm，中位数为3(3，4)mm。全部患者47例(47只眼)中，进行眶壁骨折修复者6例(6只眼)，占12.77%。其中，植入预成型小钛网未植入聚乙烯板者4例(4只眼)，占8.51%；术后6个月时两侧眼球突出度差值为3~4 mm，中位数为3(3，3.75)mm。植入预成型小钛网和聚乙烯板者1例(1只眼)，占2.13%；术后6个月时两侧眼球突出度差值为2 mm。植入预成型大钛网和聚乙烯板者1例(1只眼)，占2.13%；术后6个月时两侧眼球突出度差值为4 mm。全部患者在随访期内，均未发生并发症。

以本研究制定的规则手术治疗眼球萎缩合并眶壁骨折，术后患者双侧眼球突出度差值可控制在合理范围内，术后患者满意度高。

To explore the clinical effects of different treatment schemes for eyeball atrophy combined with orbital fractures.

47 patients (47 eyes) with ocular atrophy and orbital fractures were collected who were diagnosised in the Eye Center of Beijing Tongren Hospital affiliated to Capital Medical University from January 2017 to December 2020. Among them, there were 39 male (39 eyes) and 8 female (8 eyes) with the average age of (39.3±11.8) years (ranged from 18 to 68 years). The schemes adopted for surgical treatment were consistent with the rules. The patient′s operation plan, lesion type, implant material, diameter of implanted artificial eye table and wearing of artificial eye piece were recorded, and described by the number of cases (eyes) and percentage. The difference of bilateral exophthalmos of patients after operation for 6 months was measured and calculated, and expressed as the median and interquartile range [M(Q1, Q3)]. The patients′satisfaction with the postoperative appearance, the follow-up time and the occurrence of complications were recorded and described by the number of cases (eyes) and percentage.

All 47 patients (47 eyes) after wearing of artificial eye piece were able to adjust the difference between two sides of the eyeball protrusion to < 2 mm. By the end of the follow-up, they had all satisfied with the appearance. Among them, 19 cases (19 eyes) with simple orbital fractures without orbital fractures were only implanted with artificial eye table, accounting for 40.43%; 15 cases (15 eyes) with simple infraorbital fractures without orbital fractures were implanted with artificial eye table, accounting for 31.92%; 2 cases (2 eyes) with simple infraorbital fractures were repaired with orbital fractures and implanted with artificial eye platform, accounting for 4.26%; 7 cases (7 eyes) with orbital inner and lower wall fractures without orbital fractures repair and only implanted with artificial eye table, accounting for 14.89%; 3 cases (3 eyes) with orbital inner wall and lower wall fractures, and only were repaired with orbital lower wall fractures and implanted with artificial eye sockets, accounting for 6.38%; one case (1 eye) with orbital inner wall and lower wall fracture was repaired with orbital inner wall and lower wall and implanted with artificial eye platform, accounting for 2.13%. After the operation for 6 months, the difference of bilateral exophthalmos was 2 to 4 mm, 3 to 5 mm, 3 mm, 4 to 5 mm, 2 to 4 mm, and 4 mm, respectively; the median was 3 (2, 3) mm, 4 (3, 4) mm, 3 (3, 3) mm, 4 (4, 5) mm, 3 (2, 4) mm, and 4 (4, 4) mm, respectively. Among of 47 patients (47 eyes), 8 patients (8 eyes) were implanted with 23 mm diameter artificial eye table, accounting for 17.02%. After the operation for 6 months, the difference of bilateral exophthalmos was 3 to 5 mm, and the median was 3.5 (3, 4) mm. 39 cases (39 eyes) were implanted with 24 mm diameter artificial eye table, accounting for 82.98%. After the operation for 6 months, the difference of bilateral exophthalmos was 2 to 5 mm, and the median was 3 (3, 4) mm. 6 patients (6 eyes) with orbital fractures were repaired, accounting for 12.77%; 4 cases (4 eyes) were implanted with preforming small titanium mesh without polyethylene plate, accounting for 8.51%. After the operation for 6 months, the difference of bilateral exophthalmos was 3 to 4 mm, and the median was 3 (3, 3.75) mm. One case (1 eye) was implanted with preforming small titanium mesh and polyethylene plate, accounting for 2.13%. After the operation for 6 months, the difference between the two sides of exophthalmos was 2 mm. One case (1 eye) was implanted with preforming large titanium mesh and polyethylene plate, accounting for 2.13%. After the operation for 6 months, the difference between the two sides of exophthalmos was 4 mm. All patients′ complications were not found during the follow-up period.

According to the rules formulated in this study, the difference of bilateral exophthalmos of patients is within a reasonable range for the surgical treatment of eyeball atrophy combined with orbital fractures, and the treated patients have high gratification.