单纯性单纯性眶底爆裂骨折复视和眼球运动受限的预测因素。
The predictive factors of diplopia and extraocular movement limitations in isolated pure blow-out fracture.
作者信息
Kasaee Abolfazl, Mirmohammadsadeghi Arash, Kazemnezhad Fatemeh, Eshraghi Bahram, Akbari Mohammad Reza
机构信息
Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
出版信息
J Curr Ophthalmol. 2016 Sep 25;29(1):54-58. doi: 10.1016/j.joco.2016.09.001. eCollection 2017 Mar.
PURPOSE
To evaluate the predictive factors for development of diplopia and extraocular muscle movement (EOM) limitations in the patients with isolated pure blow-out fracture.
METHODS
One hundred thirty-two patients with isolated pure blow-out fracture were included. The diagnosis was done with computed tomography scan. Possible predictive factors were analyzed with logistic regression. The cases that underwent surgery were assigned in the surgical group, and other cases were assigned in the non-surgical group. Receiver operating characteristic (ROC) curve analysis was used in the surgical group to evaluate the power of time interval from trauma to the surgery to predict persistence of 6 months postoperative diplopia and EOM limitation.
RESULTS
At the first visit, 45 of 60 cases (75%) in the surgical group and 15 of 72 cases (20.8%) in the nonsurgical group had diplopia. After 6 months follow-up, 7 cases (11.7%) in the surgical group and 1 case (1.4%) in the nonsurgical group had persistent diplopia. Type of fracture was significantly associated with first visit diplopia (P = 0.01) and EOM limitations (P = 0.06). In the surgical group, type of fracture (P = 0.02 for both) and time interval from trauma to the surgery (P = 0.006 and 0.004, respectively) were significantly associated with 1 month diplopia and EOM limitations. Only time interval from trauma to the surgery (P = 0.04) was significantly associated with 3 months EOM limitation. In the ROC curve analysis, if the surgery was done before 4.5 (sensitivity = 87.5% and specificity = 61.3%) and 7.5 (sensitivity = 87.5% and specificity = 66.9%) days, risk of 6 months postoperative diplopia and EOM limitation was reduced, respectively.
CONCLUSIONS
In the early postoperative period, a higher rate of diplopia was observed in the patients with combined inferior and medial wall fractures and longer time intervals from trauma to the surgery. The best time for blow-out fracture surgery was within 4.5 days after the trauma.
目的
评估单纯性眼眶爆裂骨折患者发生复视及眼外肌运动（EOM）受限的预测因素。
方法
纳入132例单纯性眼眶爆裂骨折患者。通过计算机断层扫描进行诊断。采用逻辑回归分析可能的预测因素。接受手术的病例被分配到手术组，其他病例被分配到非手术组。在手术组中采用受试者工作特征（ROC）曲线分析来评估从受伤到手术的时间间隔预测术后6个月复视和EOM受限持续存在的能力。
结果
初次就诊时，手术组60例中的45例（75%）和非手术组72例中的15例（20.8%）有复视。随访6个月后，手术组7例（11.7%）和非手术组1例（1.4%）有持续性复视。骨折类型与初次就诊时的复视（P = 0.01）和EOM受限（P = 0.06）显著相关。在手术组中，骨折类型（两者均P = 0.02）和从受伤到手术的时间间隔（分别为P = 0.006和0.004）与1个月时的复视和EOM受限显著相关。只有从受伤到手术的时间间隔（P = 0.04）与3个月时的EOM受限显著相关。在ROC曲线分析中，如果在4.5天（敏感度 = 87.5%，特异度 = 61.3%）和7.5天（敏感度 = 87.5%，特异度 = 66.9%）之前进行手术，术后6个月复视和EOM受限的风险分别降低。
结论
在术后早期，下壁和内侧壁联合骨折以及从受伤到手术时间间隔较长的患者复视发生率较高。眼眶爆裂骨折手术的最佳时间是受伤后4.5天内。
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