Brucoli Matteo, Arcuri Francesco, Cavenaghi Roberta, Benech Arnaldo
Department of Maxillo-Facial Surgery, Azienda Ospedaliera Maggiore della Carità, University of Piemonte Orientale Amedeo Avogadro, Novara, Italy.
J Craniofac Surg. 2011 Jul;22(4):1387-90. doi: 10.1097/SCS.0b013e31821cc317.
The term "orbital blow-out fracture" is referred to as the mechanism by which an impact to the eyeball is transposed as a mechanical energy to the orbital walls, causing them to fracture. Despite a proper surgical technique, a successful anatomic reconstruction of the orbit, and an accurate follow-up, 3 complications are still frequently observed at long-term follow-up: diplopia, enophthalmos, and hypesthesia of the infraorbital nerve territory. In this retrospective study, we analyze the incidence, the specific characterization, and the potential risk factors of these 3 complications.
The records of 75 patients who underwent surgical repair of isolated orbital blow-out fracture from January 2001 to December 2007 at the Maxillofacial Surgery Unit of the Novara Major Hospital were reviewed retrospectively. Patients who had other coexisting facial fractures or orbital rim involvement were excluded from this study. The mean follow-up reached 39 months (range, 6-81 months). Enophthalmos was measured by a Hertel exophthalmometer; diplopia was evaluated by an optometrist with cover test, red glass test, and Hess-Lancaster test; and hypesthesia of the infraorbital nerve territory was checked by clinical examination. The studied parameters included patient's age and sex, time interval between trauma and surgery, location of the fracture, and implant material. The χ test for nonparametric data was used, and a P value of less than 0.05 was considered statistically significant.
Sex, location of the fracture, and implant material were not considered statistically significant (P > 0.05). The unique variable that influenced our data was the time interval between trauma and surgery (P > 0.05).
Although the surgical technique was executed properly and the immediate postoperative recovery was uneventful, diplopia, enophthalmos, and infraorbital nerve dysfunction were the frequent complications. We stress the fact that orbital blow-out fracture is generally not considered a technically demanding procedure, but the outcome can be very disappointing; the surgical procedure must be managed very carefully by experienced surgeons to lower the high rates of these 3 common complications. However, we can report that the incidence of diplopia, enophthalmos, and infraorbital nerve dysfunction are decreased by an immediate intervention and an early surgical repair of the orbital blow-out fracture. Patients who had surgery within 2 weeks of trauma have a lower risk to develop postoperative complications; this study supports an early surgical treatment of orbital blow-out fractures, when it is indicated.
“眼眶爆裂性骨折”一词指的是眼球受到的撞击作为机械能传递到眶壁，导致眶壁骨折的机制。尽管手术技术得当、眼眶解剖结构成功重建且随访准确，但在长期随访中仍经常观察到3种并发症：复视、眼球内陷和眶下神经分布区感觉减退。在这项回顾性研究中，我们分析了这3种并发症的发生率、具体特征和潜在危险因素。
回顾性分析了2001年1月至2007年12月在诺瓦拉市立医院颌面外科接受单纯眼眶爆裂性骨折手术修复的75例患者的病历。本研究排除了有其他并存面部骨折或眶缘受累的患者。平均随访时间为39个月（范围6 - 81个月）。眼球内陷用Hertel眼球突出计测量；复视由验光师通过遮盖试验、红玻璃试验和Hess-Lancaster试验进行评估；眶下神经分布区感觉减退通过临床检查进行检查。研究参数包括患者的年龄和性别、外伤与手术之间的时间间隔、骨折部位和植入材料。使用非参数数据的χ检验，P值小于0.05被认为具有统计学意义。
性别、骨折部位和植入材料无统计学意义（P>0.05）。影响我们数据的唯一变量是外伤与手术之间的时间间隔（P>0.05）。
尽管手术技术实施得当且术后即刻恢复顺利，但复视、眼球内陷和眶下神经功能障碍仍是常见并发症。我们强调，眼眶爆裂性骨折一般不被认为是一项技术要求很高的手术，但结果可能非常令人失望；经验丰富的外科医生必须非常谨慎地进行手术操作，以降低这3种常见并发症的高发生率。然而，我们可以报告，通过对眼眶爆裂性骨折进行即刻干预和早期手术修复，复视、眼球内陷和眶下神经功能障碍的发生率会降低。外伤后2周内进行手术的患者发生术后并发症的风险较低；本研究支持在有指征时对眼眶爆裂性骨折进行早期手术治疗。
