计算机断层扫描（CT）在预测眼眶爆裂性骨折（BOF）复视中的作用。
The role of computed tomography (CT) in predicting diplopia in orbital blowout fractures (BOFs).
作者信息
Cellina Michaela, Floridi Chiara, Panzeri Marta, Giancarlo Oliva
机构信息
Radiology Department, ASST Fatebenefratelli Sacco, Piazza Principessa Clotilde 3, 20121, Milan, Italy.
Radiology Department, IRCCS Ospedale San Raffaele, via Olgettina 60, 20132, Milan, Italy.
出版信息
Emerg Radiol. 2018 Feb;25(1):13-19. doi: 10.1007/s10140-017-1551-1. Epub 2017 Sep 14.
PURPOSE
The management of orbital blowout fractures (BOFs) is controversial: the evaluation of diplopia is the most important criterion for planning whether to undertake surgery. Our aim was to determine CT findings that may suggest the presence of diplopia when patients with BOFs cannot be adequately examined to plan an orbital repair.
METHOD AND MATERIALS
We retrospectively evaluated CT of all patients presented to our Emergency Department for blunt craniofacial trauma (N = 3334) from January 2014 to March 2016, selecting patients with CT-demonstrated BOFs. The following CT variables were assessed: fracture location, fracture multifocality, bone fragments displacement, extraocular muscles (EOM) thickening, EOM entrapment, EOM displacement, EOM hooking, intraconal and extraconal emphysema, intraconal and extraconal hematoma, and fat herniation. All patients underwent Hess-Lancaster test, to establish the presence of diplopia. After performing group comparison with Pearson χ2 test, we derived our prediction model by using logistic regression, with diplopia as the prediction and CT variables as predictors.
RESULTS
We observed 299 patients with BOFs, 46 (15.4%) with a Hess Lancaster test-proven diplopia. The CT variables with statistically significant difference between the group with diplopia and the group without diplopia were as follows: floor fracture (p = .014), bone fragments displacement (p = .001), multifocality (p = .005), EOM thickening (p = .001), EOM entrapment (p < .001), EOM displacement (p < .001), fat herniation (p = .003). The CT variables with significance as predictors of diplopia at multivariate analysis were as follows: orbital floor fracture (p value 0.015; odds ratio 2.871, 95% confidence interval of odds ratio 0.223-6.738), EOM displacement (p value 0.001; odds ratio 10.693, 95% confidence interval of odds ratio 3.761-30.401), EOM entrapment (p value 0.001; odds ratio 11.510, 95% confidence interval of odds ratio 3.059-43.306).
CONCLUSION
The presence of diplopia can be suggested on the basis of CT findings after an orbital trauma.
目的
眼眶爆裂性骨折（BOF）的治疗存在争议：复视评估是规划是否进行手术的最重要标准。我们的目的是确定在无法对眼眶爆裂性骨折患者进行充分检查以规划眼眶修复时，可能提示存在复视的CT表现。
方法与材料
我们回顾性评估了2014年1月至2016年3月因钝性颅面外伤就诊于我院急诊科的所有患者（N = 3334）的CT，选择CT显示有眼眶爆裂性骨折的患者。评估以下CT变量：骨折部位、骨折多灶性、骨碎片移位、眼外肌（EOM）增厚、眼外肌嵌顿、眼外肌移位、眼外肌钩挂、眶内和眶外气肿、眶内和眶外血肿以及脂肪疝出。所有患者均接受Hess-Lancaster试验，以确定是否存在复视。在进行Pearson χ2检验进行组间比较后，我们使用逻辑回归建立预测模型，以复视为预测指标，CT变量为预测因子。
结果
我们观察到299例眼眶爆裂性骨折患者，其中46例（15.4%）经Hess Lancaster试验证实存在复视。复视组与非复视组之间具有统计学显著差异的CT变量如下：眶底骨折（p = 0.014）、骨碎片移位（p = 0.001）、多灶性（p = 0.005）、眼外肌增厚（p = 0.001）、眼外肌嵌顿（p < 0.001）、眼外肌移位（p < 0.001）、脂肪疝出（p = 0.003）。多变量分析中作为复视预测指标具有显著性的CT变量如下：眶底骨折（p值0.015；比值比2.871，比值比的95%置信区间0.223 - 6.738）、眼外肌移位（p值0.001；比值比10.693，比值比的95%置信区间3.761 - 30.401）、眼外肌嵌顿（p值0.001；比值比11.510，比值比的95%置信区间3.059 - 43.306）。
结论
眼眶外伤后可根据CT表现提示是否存在复视。
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