醫學影像學習園地

眼眶底部破裂性骨折 Orbital floor blowout fracture

定義
眼框底破裂性骨折通常是因為眼球被大於眼框大小的物體撞擊所致。例如棒球、排球、球棒、車禍等等。眼框底破裂性骨折的特性是眼球通常不會破裂，而撞擊的能量會分布導眼框的四周並在眼框骨最薄弱的地方也就是眼框內側底部造成骨折。

Prevalence of Orbital floor blowout fracture
男性、年輕人居多。

症狀
無症狀～失明都有可能。病人在受到創傷時通常會有眼框周圍或眼皮的撕裂傷，緊接著而來的是整個眼框周圍軟組織的腫脹。此外，同側下臉頰或上齒齦麻木感也有可能發生。而自受傷後開始或受傷一周左右當眼框周圍軟組織的腫脹消退之後，有的病人會發現眼球兩邊不等高、視力喪失或複視的狀況，其中複視的狀況又以垂直方向的複視為明顯。

診斷
1. PE: Ecchymoses, ptosis, hypoglobus, enophthalmos, binocular diplopia, hypoesthesia of cheek and gum, periorbital soft tissue swelling, EOM limitation(CN Ⅲ,Ⅳ,Ⅵ), visual acuity(CNⅡ), pupils(CNⅡ,Ⅲ).

2. 影像檢查首選工具是CT

臨床案例
18-year-old healthy student suffered from binocular diplopia due to sport accident. He was hit by a volleyball result in right inferior eyelid laceration and periorbital swelling. Afterwent, uppergaze diplopia and mild hypoglobus were also noted.

18歲男性學生，因為運動傷害造成複視，他被排球打到造成右下眼瞼撕裂傷以及後續眼框周圍水腫，之後還發現眼睛上看會有複視，以及右眼輕微向下偏移的情況。

影像
Axial CT：Right periorbital soft tissue swelling. Some fluid accumulated in maxillary sinus(dot arrow) and an in-continuous cortex line in right orbital floor suspected a linear fracture.


Sagital CT: an in-continuous cortex line in right orbital floor suspected a linear fracture.


Coronal CT: Loss of orbital floor on the right side. Entrapped inferior rectus muscle, maxillary hemosinus and an in-continuous cortex line in right orbital floor suspected a linear fracture(arrow) were also noted.


連續影像