Schouman Thomas, Courvoisier Delphine S, Van Issum Christopher, Terzic Andrej, Scolozzi Paolo
Service of Oral and Maxillofacial Surgery, Department of Surgery, University Hospital and Faculty of Medicine of Geneva, Geneva, Switzerland.
J Oral Maxillofac Surg. 2012 Jul;70(7):1627-32. doi: 10.1016/j.joms.2012.03.006.
To describe and evaluate the reliability and the accuracy of a specific computed tomography-based assessment in predicting treatment decisions for pure orbital floor blowout fractures (BOFs).
In this retrospective cohort study, the charts of all patients presenting with isolated BOFs from January 2009 through April 2011 at the University Hospital of Geneva were reviewed. The systematic computed tomographic assessment included the following 3 parameters: 1) ratio of the fractured orbital floor; 2) maximal height of periorbital tissue herniation, and 3) a 4-grade muscular subscore describing the position of the inferior rectus muscle relative to the level of the orbital floor. The parameters' predictive value regarding the treatment decision (conservative vs surgical) was assessed by logistic regression and relative operating characteristic curves.
Forty-eight patients (24 male) were included. The patients' mean age was 49.5 years. The ratio of the fractured orbital floor, the maximal height of periorbital tissue herniation, and the muscular subscore were significant predictors in univariate analysis (P = .02, P = .006, P = .001, respectively), whereas, in a multivariate analysis, only muscular subscore remained a significant predictor (P = .003) and reached a similar predictive ability as the 3 parameters together.
The present study showed that the severity of inferior rectus muscle displacement is the most important independent predictive radiologic factor in the treatment decision-making process for pure BOFs. This systematic computed tomographic assessment is a valuable tool for a better understanding of BOF management overall. Further studies are needed to establish its clinical relevance.
描述并评估基于计算机断层扫描的特定评估方法在预测单纯眶底爆裂性骨折（BOF）治疗决策方面的可靠性和准确性。
在这项回顾性队列研究中，对2009年1月至2011年4月在日内瓦大学医院就诊的所有单纯BOF患者的病历进行了回顾。系统性计算机断层扫描评估包括以下3个参数：1）骨折眶底的比例；2）眶周组织疝出的最大高度；3）一个4级肌肉评分，描述下直肌相对于眶底水平的位置。通过逻辑回归和相对操作特征曲线评估这些参数对治疗决策（保守治疗与手术治疗）的预测价值。
纳入48例患者（24例男性）。患者的平均年龄为49.5岁。在单因素分析中，骨折眶底的比例、眶周组织疝出的最大高度和肌肉评分是显著的预测因素（分别为P = 0.02、P = 0.006、P = 0.001），而在多因素分析中，只有肌肉评分仍然是显著的预测因素（P = 0.003），并且其预测能力与这3个参数综合起来时相似。
本研究表明，下直肌移位的严重程度是单纯BOF治疗决策过程中最重要的独立预测性影像学因素。这种系统性计算机断层扫描评估是全面更好地理解BOF治疗的有价值工具。需要进一步研究来确定其临床相关性。
