Hoelzle F, Klein M, Schwerdtner O, Lueth T, Albrecht J, Hosten N, Felix R, Bier J
Department of Oral and Maxillofacial Surgery, University Hospital Charité, Berlin, Germany.
Int J Oral Maxillofac Surg. 2001 Feb;30(1):26-31. doi: 10.1054/ijom.2000.0014.
Up to now it has only been possible to monitor the alignment of orbital floor fractures postoperatively with a computed tomography (CT) examination with coronal sectioning. If this showed an incorrect positioning, renewed surgery and anaesthetics were often required. The purpose of this study was the implementation and definition of the spectrum of indications for intraoperative CT examinations while keeping patient radiation exposure to a minimum. Thirty-two orbital fracture cases were examined pre- and intraoperatively using the mobile computer tomograph Tomoscan M in coronal sectioning. In this patient collective, 12 cases showed an isolated orbital floor fracture and twenty cases an orbital floor fracture associated with a zygomatic fracture. The technical prerequisite for these examinations was the construction of a suitable radiolucent operating table which permitted coronal sections to be made with the CT-Gantry tilted. The authors aimed to reduce radiation exposure by optimizing the technical setting parameters and closely defining the scan region for the operator. In three of 32 cases there were no surgical indications following clinical and preoperative CT examination. In three of the 20 cases with associated zygomatic fracture a closed reduction with a reduction hook was carried out, and no revision was necessary after the intraoperative CT examination. In 26 cases an open reduction was carried out. Of these open reduced fractures, four had to be revised after intraoperative CT monitoring; one of the isolated orbital floor fractures and three of those associated with a zygomatic fracture. Intraoperative CT monitoring of orbital floor fractures is considered a useful surgical aid. Its advantages are immediate monitoring of the surgical reduction, the presence of the surgeon during scanning enabling him to determine directly the relevant sections to scan, and the resulting radiation exposure.
到目前为止，术后只能通过计算机断层扫描（CT）冠状位切片检查来监测眶底骨折的复位情况。如果显示定位不正确，往往需要再次手术和麻醉。本研究的目的是在将患者辐射暴露降至最低的同时，实施并明确术中CT检查的适应证范围。使用移动计算机断层扫描仪Tomoscan M对32例眶骨折患者进行了术前和术中冠状位切片检查。在这个患者群体中，12例显示单纯眶底骨折，20例显示眶底骨折合并颧骨骨折。这些检查的技术前提是构建一个合适的可透射线手术台，该手术台允许在CT机架倾斜的情况下进行冠状位切片。作者旨在通过优化技术设置参数并为操作人员精确界定扫描区域来减少辐射暴露。32例中有3例在临床和术前CT检查后无手术指征。20例合并颧骨骨折的病例中有3例使用复位钩进行了闭合复位，术中CT检查后无需翻修。26例进行了切开复位。在这些切开复位的骨折中，4例在术中CT监测后需要翻修；1例为单纯眶底骨折，3例为合并颧骨骨折的病例。术中CT监测眶底骨折被认为是一种有用的手术辅助手段。其优点是能即时监测手术复位情况，扫描时外科医生在场使其能够直接确定相关扫描层面，以及由此带来的辐射暴露情况。
