眼眶骨折伴神经损伤后持续性复视。

Stockholm Craniofacial Center, Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.

Department of General Surgery, Sundsvall, Sweden.

J Plast Reconstr Aesthet Surg. 2015 Feb;68(2):219-25. doi: 10.1016/j.bjps.2014.10.040. Epub 2014 Nov 6.

BACKGROUND

Fractures in the facial skeleton are common and may lead to orbital sequelae caused by the injury and/or the surgery. In this long-term follow-up, we examined the nature of sequelae after facial fractures involving the orbit and whether a higher complexity of the fractures produced more sequelae compared to simpler fracture patterns, and if so, to what extent.

METHODS

Patients surgically treated for facial fractures involving the orbit at the Karolinska University Hospital with a follow-up duration of ≥3 years were included in this retrospective study and were examined by a neuro-ophthalmologist. Based on the location and severity of the fractures, the patients were divided into four groups according to fracture complexity: 1) isolated zygomatic fracture, 2) isolated orbital floor blowout fracture, 3) zygomatic fracture combined with blowout fracture and 4) bilateral or multiple fracture patterns.

RESULTS

Out of 154 patients, 81 patients (53%) attended follow-up examinations, 65 male (80%) and 16 female (20%). The duration of follow-up was 3.0-7.6 years (mean of 4.9 years). The incidence of diplopia was 3.7%, visual loss 2.5%, dystopia 4.9% and visible enophthalmos (>2 mm) 8.6%. Severe diplopia (2.5%) was due to nerve injuries. Visual loss was encountered only in group 4 with complex fractures. Fracture complexity had an effect on the presence of any sequelae, with group 4 presenting a higher percentage of patients with sequelae than the other three groups. However, no statistically significant effect of group could be found on the individual, quantitative output values of dystopia and enophthalmos.

CONCLUSIONS

In this study, severe persistent diplopia in patients was due to nerve injuries, which emphasizes the need for preoperative ophthalmologic examinations, in all patients with fractures involving the orbit. A higher fracture complexity was found to lead to a higher percentage of patients presenting sequelae.

背景

面部骨骼骨折很常见，可能导致因受伤和/或手术引起的眼眶后遗症。在这项长期随访中，我们检查了涉及眼眶的面部骨折后的后遗症的性质，以及骨折的复杂性是否比简单的骨折模式产生更多的后遗症，如果是，程度如何。

方法

这项回顾性研究纳入了在卡罗林斯卡大学医院接受涉及眼眶的面部骨折手术治疗且随访时间≥3 年的患者，并由神经眼科医生进行检查。根据骨折的位置和严重程度，患者根据骨折复杂性分为四组：1）孤立性颧骨骨折，2）孤立性眶底爆裂性骨折，3）颧骨骨折合并爆裂性骨折，4）双侧或多发性骨折模式。

结果

在 154 例患者中，81 例（53%）接受了随访检查，其中 65 例为男性（80%），16 例为女性（20%）。随访时间为 3.0-7.6 年（平均 4.9 年）。复视发生率为 3.7%，视力丧失 2.5%，斜视 4.9%，可见眼球内陷（>2mm）8.6%。严重复视（2.5%）是由于神经损伤所致。只有在骨折复杂的 4 组中才发现视力丧失。骨折复杂性对任何后遗症的存在都有影响，4 组出现后遗症的患者比例高于其他三组。然而，在斜视和眼球内陷的个体、定量输出值方面，组间没有统计学意义的差异。