Wi J M, Sung K H, Chi M
Department of Ophthalmology, Konyang University, Kim's Eye Hospital, Seoul, Korea.
Department of Radiation Oncology, Gachon University Gil Medical Center, Incheon, Korea.
Eye (Lond). 2017 May;31(5):713-719. doi: 10.1038/eye.2016.311. Epub 2017 Jan 13.
PurposeTo evaluate the effect of orbital reconstruction and factors related to the effect of orbital reconstruction by assessing of orbital volume using orbital computed tomography (CT) in cases of orbital wall fracture.MethodsIn this retrospective study, 68 patients with isolated blowout fractures were evaluated. The volumes of orbits and herniated orbital tissues were determined by CT scans using a three-dimensional reconstruction technique (the Eclipse Treatment Planning System). Orbital CT was performed preoperatively, immediately after surgery, and at final follow ups (minimum of 6 months). We evaluated the reconstructive effect of surgery making a new formula, 'orbital volume reconstruction rate' from orbital volume differences between fractured and contralateral orbits before surgery, immediately after surgery, and at final follow up.ResultsMean volume of fractured orbits before surgery was 23.01±2.60 cm and that of contralateral orbits was 21.31±2.50 cm (P=0.005). Mean volume of the fractured orbits immediately after surgery was 21.29±2.42 cm, and that of the contralateral orbits was 21.33±2.52 cm (P=0.921). Mean volume of fractured orbits at final follow up was 21.50±2.44 cm, and that of contralateral orbits was 21.32±2.50 cm (P=0.668). The mean orbital volume reconstruction rate was 100.47% immediately after surgery and 99.17% at final follow up. No significant difference in orbital volume reconstruction rate was observed with respect to fracture site or orbital implant type. Patients that underwent operation within 14 days of trauma had a better reconstruction rate at final follow up than patients who underwent operation over 14 days after trauma (P=0.039).ConclusionComputer-based measurements of orbital fracture volume can be used to evaluate the reconstructive effect of orbital implants and provide useful quantitative information. Significant reduction of orbital volume is observed immediately after orbital wall reconstruction surgery and the reconstruction effect is maintained for more than minimum 6 months. Patients that undergo surgery within 14 days of trauma has better reconstruction rates at final follow up, which supports the need for early surgery.
通过对眼眶壁骨折患者进行眼眶计算机断层扫描（CT）评估眼眶容积，以评价眼眶重建效果及与眼眶重建效果相关的因素。
在这项回顾性研究中，对68例单纯性爆裂性骨折患者进行了评估。采用三维重建技术（Eclipse治疗计划系统）通过CT扫描确定眼眶及疝出眼眶组织的容积。术前、术后即刻及最终随访（至少6个月）时均进行眼眶CT检查。我们根据术前、术后即刻及最终随访时骨折眼眶与对侧眼眶的容积差异，制定了一个新公式“眼眶容积重建率”，以评估手术的重建效果。
术前骨折眼眶的平均容积为23.01±2.60 cm，对侧眼眶的平均容积为21.31±2.50 cm（P = 0.005）。术后即刻骨折眼眶的平均容积为21.29±2.42 cm，对侧眼眶的平均容积为21.33±2.52 cm（P = 0.921）。最终随访时骨折眼眶的平均容积为21.50±2.44 cm，对侧眼眶的平均容积为21.32±2.50 cm（P = 0.668）。术后即刻平均眼眶容积重建率为100.47%，最终随访时为99.17%。在骨折部位或眼眶植入物类型方面，眼眶容积重建率无显著差异。创伤后14天内接受手术的患者在最终随访时的重建率优于创伤后14天以上接受手术的患者（P = 0.039）。
基于计算机的眼眶骨折容积测量可用于评估眼眶植入物的重建效果，并提供有用的定量信息。眼眶壁重建手术后即刻观察到眼眶容积显著减小，且重建效果至少维持6个月以上。创伤后14天内接受手术的患者在最终随访时有更好的重建率，这支持了早期手术的必要性。
