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目的探讨外伤性眶内血肿的影像学诊断价值和治疗原则。方法8例行眼眶轴位和冠状位CT扫描,部分病例再行眼科B超扫描或MRI检查。治疗方法:眼球突出进行性加重、眶压急剧增高、视力急剧下降或丧失者,行开眶手术并引流;晚期就诊,眼球突出明显、眼球运动障碍者,在B超引导下穿刺抽出已液化的积血;轻度突眼、眶内压增高不明显、视力未受影响者,给予冷敷、加压包扎和止血剂等保守治疗。结果CT显示血肿位于眶顶骨膜下者居多,显示为边界清楚、密度较均匀的高密度影。超声显示早期血肿边界清楚、内回声不均匀,晚期血肿为无回声液性暗区。MRI检查晚期血肿T1及T2加权像均显示为高信号区。治疗后视力下降者中,2例24h就诊者视力恢复正常,1例3d就诊者视力由0.2提高到0.5,1例16d就诊及1例视力丧失者视力无改善。结论建议CT作为外伤性眶内血肿的首选早期诊断方法。根据就诊时间和病情的不同采取开眶引流、穿刺抽血或冷敷加压等治疗方法。。
Objective To investigate the diagnostic value and treatment principles of traumatic orbital hematoma. Methods Eight cases were performed with orbital axial and coronal CT scan. In some cases, B-scan or MRI was performed again. Treatment methods: exacerbated orbital exacerbation, orbital pressure increased sharply, decreased visual acuity or loss of persons, orbital surgery and drainage; late treatment, prominent eyeballs, eye movement disorders, under the guidance of B ultrasound puncture out liquefied Hemorrhage; mild exophthalmos, increased orbital pressure is not obvious, visual acuity was not affected, given cold compress, bandaged and hemostatic agents such as conservative treatment. Results CT showed hematoma in the orbital subperiosteal majority, showed a clear boundary, the density of more uniform high-density shadow. Ultrasound showed a clear boundary of early hematoma, the echo is not uniform, advanced hematoma anechoic dark area. MRI examination of late hematoma T1 and T2 weighted images showed high signal area. After treatment, the visual acuity decreased in 2 cases, 24 hrs visual acuity returned to normal, visual acuity improved from 0.2 to 0.5 in 1 case of 3 cases, 1 case of 16d treatment and 1 case of vision loss without improvement of visual acuity. Conclusion CT is recommended as the first choice of early diagnosis of traumatic orbital hematoma. According to the time of visit and the different conditions to open orbital drainage, puncture blood pressure or cold compress therapy. .