Dutton G N, al-Qurainy I, Stassen L F, Titterington D M, Moos K F, el-Attar A
Tennent Institute of Ophthalmology, Western Infirmary, Glasgow.
Eye (Lond). 1992;6 ( Pt 1):86-9. doi: 10.1038/eye.1992.17.
Fractures of the mid-face are commonly accompanied by injury to the visual system. Three hundred and sixty three patients who had sustained mid-facial fractures were assessed prospectively for evidence of such injury. The data have been used to devise a scoring system for the maxillofacial surgeon in order to help identify those patients at risk of eye injury. The scoring system has been evaluated on a further cohort of 100 patients with a similar spectrum of injury and the sensitivity and specificity of the system have been determined. The results of these studies have been reported in the maxillofacial literature. This paper reviews the data and results obtained. In summary, impaired visual acuity with a comminuted or out blow fracture, a motility abnormality, or facial fracture combined with head injury, sufficient to cause both retrograde and post-traumatic amnesia, emerged as major risk factors which are indicative of an adverse ophthalmic outcome deemed to warrant referral. The scoring system which was developed from this data was found to have a sensitivity of 94.4% and a specificity of 89% for the detection of patients thought to merit ophthalmic assessment. Failure to assess central visual function as objectively as practicable in patients who have sustained mid-facial fractures may lead to potentially treatable ophthalmic pathology not being identified.
面中部骨折常伴有视觉系统损伤。对363例面中部骨折患者进行了前瞻性评估，以寻找此类损伤的证据。这些数据已被用于为颌面外科医生设计一个评分系统，以帮助识别有眼部损伤风险的患者。该评分系统已在另一组100例具有类似损伤范围的患者中进行了评估，并确定了该系统的敏感性和特异性。这些研究结果已在颌面外科文献中报道。本文回顾了所获得的数据和结果。总之，粉碎性或外击性骨折导致的视力受损、眼球运动异常，或面部骨折合并头部损伤，足以导致逆行性和创伤后失忆，这些都是主要的危险因素，表明眼科预后不良，被认为需要转诊。从这些数据中开发出的评分系统在检测被认为值得进行眼科评估的患者时，敏感性为94.4%，特异性为89%。对于面中部骨折患者，如果未能尽可能客观地评估其中心视觉功能，可能会导致潜在可治疗的眼科病变未被发现。
