Shin Kyung Jin, Lee Dong Geun, Park Hyun Min, Choi Mi Young, Bae Jin Ho, Lee Eui Tae
Department of Plastic and Reconstructive Surgery, Chungbuk National University College of Medicine, Cheongju, Korea.
Arch Plast Surg. 2013 Nov;40(6):721-7. doi: 10.5999/aps.2013.40.6.721. Epub 2013 Nov 8.
One of the main concerns in orbital blowout fracture repair is a narrow operation field, due mainly to the innate complex three dimensions of the orbit; however, a deep location and extensive area of the fracture and soft tissue edema can also cause concern. Swelling of the orbital contents progresses as the operation continues. Mannitol has been used empirically in glaucoma, cerebral hemorrhage, and orbital compartment syndrome for decompression. The authors adopted mannitol for the control of intraorbital edema and pressure in orbital blowout fracture repair.
This prospective study included 108 consecutive patients who were treated for a pure blowout fracture from January 2007 to October 2012. For group I, mannitol was administered during the operation. Under general anesthesia, all patients underwent surgery by open reduction and insertion of an absorbable mesh implant. The authors compared postoperative complications, the reoperation rate, operation time, and surgical field improvement between the two groups.
In patients who received intraoperative administration of mannitol, the reoperation rate and operation time were decreased; however, the difference was not statistically significant. The total postoperative complication rates did not differ. Panel assessment for the intraoperative surgical field video recordings showed significantly improved vision in group I.
For six years, mannitol proved itself an effective, reliable, and safe adjunctive drug in the repair of orbital blowout fractures. With its rapid onset and short duration of action, mannitol could be one of the best methods for obtaining a wider surgical field in blowout fracture defects.
眼眶爆裂骨折修复术中的主要问题之一是手术视野狭窄，这主要归因于眼眶固有的复杂三维结构；然而，骨折的深部位置、广泛区域以及软组织水肿也会引发问题。随着手术的进行，眶内容物的肿胀会加剧。甘露醇已被经验性地用于青光眼、脑出血和眼眶间隔综合征的减压治疗。作者采用甘露醇来控制眼眶爆裂骨折修复术中的眶内水肿和压力。
这项前瞻性研究纳入了2007年1月至2012年10月期间连续治疗的108例单纯爆裂骨折患者。对于第一组，在手术期间给予甘露醇。在全身麻醉下，所有患者均接受切开复位并植入可吸收网状植入物的手术。作者比较了两组患者的术后并发症、再次手术率、手术时间和手术视野改善情况。
术中接受甘露醇治疗的患者，再次手术率和手术时间有所降低；然而，差异无统计学意义。术后总并发症发生率无差异。对术中手术视野视频记录的小组评估显示，第一组的视野有显著改善。
六年来，甘露醇在眼眶爆裂骨折修复中证明了自己是一种有效、可靠且安全的辅助药物。由于其起效迅速、作用时间短，甘露醇可能是在爆裂骨折缺损中获得更广阔手术视野的最佳方法之一。
