一侧额眶严重交通伤的临床特点及救治

    Clinical features and treatment of severe lateral frontal orbit traffic injuries

    • 摘要: 目的: 探讨一侧额眶部严重交通伤的临床特点及救治。方法: 回顾性分析27例一侧额眶部严重交通伤患者临床资料。结果: 开放性损伤多,意识障碍多较轻,眼部并发症多,远期精神障碍明显。影像学常见着力侧额骨、眶骨、筛骨、蝶骨骨折,局限于额、颞叶的脑挫裂伤、脑内血肿,局限于额颞部、前颅底的硬膜外、下血肿。另外可见视神经管骨折,眼球突出或破裂萎陷。27例均随访6~12个月,综合其神经功能、面容整复、脑脊液漏及精神功能4个方面,大多数患者预后良好,GOSⅠ级18例,整形效果满意。结论: 一侧额眶部交通伤发生率高。损伤特点与交通伤类型、着力部位的生理解剖特点有关。救治原则:争取一期手术彻底清创,清除颅内血肿和破碎坏死脑组织以防脑疝,额眶骨折整复矫畸,视神经管减压以挽救视力及脑脊液漏修补以防颅内感染。

       

      Abstract: Objective: To explore the clinical features and treatment of severe lateral frontal orbit traffic injury.Methods: Clinical data of 27 such patients treated from June 1998 to August 2002 were retrospectively analyzed.Results: The injuries caused by traffic blunt force impact were located on one side of frontal orbit,with confined but complicated wounds.The sufferers had severe open injury,disturbed by slight consciousness disorder with many eye complications.The prospect of mental disorder was obvious.All had mild combined general injury with few contrecoup contusion of brain located in the frontal and temporal lobes and with intracerebral hematoma as well as peridural and subdural hematoma confined to frontotemporale and anterior basocranium.The optic canal fracture and exophthalmus were also commonly seen.Conclusions: Lateral frontal orbit traffic injury is characteristic of high incidence.Its characteristics are related to physiological-anatomic ones in terms of types and impacted areas in traffic injury.It is required in phase I operation that thorough debridement be performed,intracranial hematoma and fragments of necrotic brain tissues be removed in order to prevent cerebral hernia,reduction of fractured frontal orbit be conducted,optic canal be depressurized to save vision and leakage of cerebrospinal fluid be repaired to avoid intracranial infection.

       

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