Matic Damir B, Tse Raymond, Banerjee Avik, Moore Cory C
Division of Plastic and Reconstructive Surgery, University of Western Ontario, London, Canada.
J Craniofac Surg. 2007 Jan;18(1):127-32. doi: 10.1097/SCS.0b013e31802ccdc8.
In spite of established indications for early operative repair of orbital floor fractures 7-10% of patients treated nonoperatively develop enophthalmos. Clearly further indications for repair are required to prevent these post-injury complications. Rounding of the inferior rectus muscle on coronal computerized tomography (CT) scan results from a loss of soft tissue and bony support and may therefore be predictive of late enophthalmos.A four-year institutional review was conducted to identify patients with orbital floor fractures that had been treated nonoperatively. Patients were recruited for late clinical follow-up (mean 30 months) where clinically significant enophthalmos and diplopia were measured. Clinical results were correlated with measurements of the height-to-width ratio of the inferior rectus muscle on CT scans by a blinded examiner. Eighteen of 78 patients were available for late follow-up. Sixteen patients had no enophthalmos whereas 2 patients had enophthalmos. The inferior rectus height-to-width ratios measured in the unaffected orbits were statistically similar between the two groups. There was a significantly increased height-to-width ratio exceeding 1.00 in the affected orbit when the enophthalmos group was compared to the no enophthalmos group.A height-to-width ratio of the inferior rectus muscle on coronal CT scan of greater than or equal to 1.00 is predictive of late enophthalmos.
尽管早期手术修复眶底骨折已有明确指征，但接受非手术治疗的患者中有7% - 10%会出现眼球内陷。显然，需要进一步明确修复指征以预防这些损伤后并发症。冠状位计算机断层扫描（CT）上眼直肌下直肌变圆是软组织和骨性支撑缺失的结果，因此可能预示晚期眼球内陷。进行了一项为期四年的机构回顾，以确定接受非手术治疗的眶底骨折患者。招募患者进行晚期临床随访（平均30个月），测量具有临床意义的眼球内陷和复视情况。由一名不知情的检查者将临床结果与CT扫描上眼直肌高宽比的测量结果进行关联。78名患者中有18名可进行晚期随访。16名患者无眼球内陷，而2名患者有眼球内陷。两组患者未受影响眼眶中测量的下直肌高宽比在统计学上相似。与无眼球内陷组相比，眼球内陷组患侧眼眶的高宽比显著增加，超过1.00。冠状位CT扫描上眼直肌高宽比大于或等于1.00可预示晚期眼球内陷。
