Rhee Seung-Hyun, Kim Tae-Seup, Song Jae-Min, Shin Sang-Hoon, Lee Jae-Yeol
Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University.
Maxillofac Plast Reconstr Surg. 2014 Nov;36(6):273-9. doi: 10.14402/jkamprs.2014.36.6.273. Epub 2014 Nov 12.
This study assessed the association between eye symptoms (enophthalmos or diplopia) and site of damage, volume, deviated inferior rectus muscle (IRM) and type of fracture with computed tomography (CT). The intent is to anticipate the prognosis of orbital trauma at initial diagnosis.
Forty-five patients were diagnosed with fractures of the inferior wall of one orbit. Fracture area, volume of displaced tissue, deviated IRM, and type of fracture were evaluated from coronal CT by one investigator. The association of those variables with the occurrence of eye symptoms (diplopia and enophthalmos) was assessed.
Of 45 patients, 27 were symptom-free (Group A) and 18 had symptoms (Group B) of enophthalmos and/or diplopia. In Group B, 12 had diplopia, one was enophthalmos, and five had both. By CT measurement, group A mean area was 192.6 mm(2) and the mean volume was 673.2 mm(3). Group B area was 316.2 mm(2) and volume was 1,710.6 mm(3). The volume was more influential on symptom occurrence. Each patient was categorized into four grades depending on the location of IRM. Symptom occurrence and higher grade were associated. Twenty-six patients had trap-door fracture (one side, attached to the fracture), and 19 had punched-out fracture (both sides detached). The punched-out fracture was more strongly associated with symptoms and had statistically significantly higher area and volume.
In orbital trauma, measurement of fracture area and volume, evaluation of the deviated IRM and classification of the fracture type by coronal CT can effectively predict prognosis and surgical indication.
本研究通过计算机断层扫描（CT）评估眼部症状（眼球内陷或复视）与损伤部位、体积、下直肌（IRM）移位及骨折类型之间的关联。目的是在初次诊断时预测眼眶创伤的预后。
45例患者被诊断为单眼眶下壁骨折。由一名研究人员通过冠状位CT评估骨折面积、移位组织体积、IRM移位及骨折类型。评估这些变量与眼部症状（复视和眼球内陷）发生之间的关联。
45例患者中，27例无症状（A组），18例有眼球内陷和/或复视症状（B组）。在B组中，12例有复视，1例有眼球内陷，5例两者皆有。通过CT测量，A组平均面积为192.6平方毫米，平均体积为673.2立方毫米。B组面积为316.2平方毫米，体积为1710.6立方毫米。体积对症状发生的影响更大。根据IRM的位置将每位患者分为四个等级。症状发生与较高等级相关。26例患者为活板门骨折（一侧，与骨折相连），19例为打孔骨折（两侧分离）。打孔骨折与症状的关联更强，且面积和体积在统计学上显著更高。
在眼眶创伤中，通过冠状位CT测量骨折面积和体积、评估IRM移位及骨折类型分类可有效预测预后和手术指征。
