目的 探究高密度多孔聚乙烯（Medpor）填充物经鼻内镜泪阜切口植入治疗眶内壁骨折的围手术期综合性护理干预的临床应用价值。方法 选取2021年1月—2024年1月收治的眶内壁骨折伴眼球内陷及复视的患者17例,经影像学确定骨折范围及软组织损伤程度后于全身麻醉下经鼻内镜下做泪阜切口,将凹陷的眶内容物还纳至眶内,并植入Medpor填充物修补骨折部位,评价手术后治疗结果;围手术期配合综合性护理干预,比较护理前后患者焦虑、抑郁及生活质量评分,记录患者对护理的满意度。结果 手术后患者复视、双眼突出度差值、眼球运动分级及最佳矫正视力均较手术前明显改善（P<0.05）,治疗有效率为94.12%。所有患者顺利完成手术,随访期间未出现感染、填充物移位以及排斥反应等并发症。手术后3个月,患者结膜组织水肿和眼睑水肿比例均较手术后1周明显降低（P<0.05）。围手术期配合综合性护理干预后,患者SAS评分和SDS评分均较干预前明显降低（P<0.05）,生活质量评分较干预前明显升高（P<0.05）,患者对护理的满意率为88.24%。结论 Medpor填充物经鼻内镜泪阜切口植入治疗眶内壁骨折效果显著,手术成功率高,并发症发生率低。围手术期配合综合性护理干预能够改善患者焦虑、抑郁情绪,提高生活质量,值得临床推广。
Objective To explore the perioperative comprehensive nursing of porous high-density polyethylene（Medpor） implant through endoscopic transcaruncular approach in the treatment of medial orbital fracture. Methods A total of 17 patients with medial orbital fracture accompanied by enophthalmos and diplopia admitted from January 2021 to January 2024 were selected. After determining the fracture scope and soft tissue injury degree by imaging, an endoscopic transcaruncular approach was used under general anesthesia to restore depressed orbital contents into the orbit and reconstruct the fracture site by Medpor implant. The postoperative outcomes were evaluated. In the perioperative period, after comprehensive nursing intervention was implemented, patients' anxiety, depression, and life quality scores were compared before and after nursing, and patients' satisfaction with nursing was recorded. Results After operation, diplopia, binocular prominence difference, eye movement grade, and best corrected visual acuity were all significantly improved than those before （P<0.05）, and the treatment effective rate was 94.12%. All patients successfully completed the operation, and no complications such as infection, displacement of implant, or rejection occurred during the follow-up period. The proportions of patients with conjunctival tissue edema and eyelid edema at 3 months after operation were significantly lower than those at 1 week after operation （P<0.05）. After comprehensive nursing intervention in the perioperative period, the SAS score and SDS score of patients after nursing were significantly lower than before （P<0.05）, the quality of life score was significantly higher than before （P<0.05）, and the nursing satisfaction rate was 88.24%. Conclusion Medpor implant through endoscopic transcaruncular approach is effective in the treatment of medial orbital fracture, with high surgical success rate and rare complications. Perioperative comprehensive nursing intervention can relieve patients' anxiety and depression and improve the quality of life, which is worthy of clinical promotion.
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