He Dongmei, Blomquist Preston H, Ellis Edward
University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA.
J Oral Maxillofac Surg. 2007 Apr;65(4):713-20. doi: 10.1016/j.joms.2006.09.006.
The physical mechanism of orbital blowout fractures has been debated for years by surgeons. Three main theories have been promulgated, including the hydraulic theory, the contact of globe-to-orbital wall theory, and the bone buckling theory. One might anticipate a strong association of blowout fractures and traumatically induced ocular injuries with the hydraulic and globe-to-wall theories because in both, the force is delivered directly to the ocular globe. This study was performed to assess the association between orbital blowout fractures and ocular injuries.
Records of patients with orbital blowout fractures were collected from a single hospital. Those with complete records that included a thorough ophthalmologic examination were collected, and information about the nature of the injury to the bone and the ocular globe was tabulated.
A total of 225 patients ranging in age from 13 to 98 years (mean, 34.9 yr) who had sustained 240 blowout fractures (15 were bilateral) met the inclusion criteria. In all, 53 fractures (22%) involved ocular injuries that were thought to be directly associated with ocular trauma. The most common positive ocular finding was commotio retinae, which was present in 21 of 60 globes with significant traumatic ocular findings. This was followed in frequency by traumatic mydriasis (19 globes) and traumatic iritis (15 globes). Most ocular injuries were minor.
The low incidence of significant ocular injury may indicate that direct contact of the globe with the traumatic force is not common. This finding gives credence to the buckling theory of blowout fracture, which seems more likely in most cases.
多年来，外科医生一直在争论眼眶爆裂性骨折的物理机制。已提出三种主要理论，包括液压理论、眼球与眶壁接触理论和骨屈曲理论。人们可能会预期，爆裂性骨折与创伤性眼损伤之间存在很强的关联，这与液压理论和眼球与眶壁理论有关，因为在这两种理论中，力都是直接作用于眼球的。本研究旨在评估眼眶爆裂性骨折与眼损伤之间的关联。
从一家医院收集眼眶爆裂性骨折患者的记录。收集那些有完整记录且包括全面眼科检查的患者，并将有关眼眶骨和眼球损伤性质的信息制成表格。
共有225例年龄在13至98岁（平均34.9岁）之间的患者发生了240处爆裂性骨折（15处为双侧骨折），符合纳入标准。总共有53处骨折（22%）涉及被认为与眼外伤直接相关的眼损伤。最常见的眼部阳性发现是视网膜震荡，在60只出现明显创伤性眼部表现的眼球中，有21只出现该症状。其次是外伤性瞳孔散大（19只眼球）和外伤性虹膜炎（15只眼球）。大多数眼损伤为轻度损伤。
严重眼损伤的低发生率可能表明眼球与创伤力的直接接触并不常见。这一发现支持了爆裂性骨折的屈曲理论，在大多数情况下该理论似乎更有可能成立。
