Kovar Daniel, Holy Richard, Voldrich Zdenek, Voska Pavel, Lestak Jan, Astl Jaromir
Department of ENT and Maxillofacial surgery, 3rd Faculty of Medicine, Charles University in Prague and Military University Hospital Prague, Czech Republic.
Faculty of Military Health Science in Hradec Kralove, University of Defence, Hradec Kralove, Czech Republic.
Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2018 Mar;162(1):61-64. doi: 10.5507/bp.2017.037. Epub 2017 Aug 31.
Backgroung and Aim. This work builds on our publication on the subject of creating a mathematical model for calculating the volume of proplaped soft tissue of the orbit in blow-out fractures, which aids us greatly in our choice of the most effective treatment immediately post-accident.
In this prospective study (2014 - 2016) we treated 29 patients with blow-out fractures. 18 (62%) were treated conservatively and in 11 (38%) we proceeded surgically. We decided whether surgical or non-surgical therapy was appropriate on the basis of clinical ENT, eye examination and the total volume of prolapsed orbital soft tissue. All procedures were perfomed by the same operating team with a uniform subciliary approach and using PMR splints adapted to the correct size and shape.
On the basis of the mathematical model we reassessed findings in 2 patients: in one we decided against a surgical solution and in the other a surgical approach was indicated. All 18 patients treated conservatively, fully recovered and are free of diplopia. The 11 operated patients are also free of diplopia, only 1 patient (3%) displays clinically insignificant postoperative diplopia in extreme posisitons when looking upwards.
With proper selection of the optimal treatment, the rate of complete disappearance of diplopia and fully preserved motility of the eyeball ranges from 91 to 97%. Surgical treatment of orbital floor fractures is important, mainly to minimise persistent post-traumatic diplopia which significantly reduces a patient's quality of life.
背景与目的。本研究基于我们之前发表的关于创建计算眼眶爆裂骨折中脱垂软组织体积的数学模型的论文，该模型在事故发生后立即选择最有效的治疗方法时对我们帮助极大。
在这项前瞻性研究（2014 - 2016年）中，我们治疗了29例眼眶爆裂骨折患者。18例（62%）接受了保守治疗，11例（38%）接受了手术治疗。我们根据临床耳鼻喉科、眼科检查以及脱垂眼眶软组织的总体积来决定手术或非手术治疗是否合适。所有手术均由同一手术团队进行，采用统一的睑缘下入路，并使用尺寸和形状合适的PMR夹板。
基于数学模型，我们对2例患者的检查结果进行了重新评估：其中1例我们决定不采取手术治疗，另一例则建议采取手术治疗。所有18例接受保守治疗的患者均完全康复，无复视。11例接受手术治疗的患者也无复视，只有1例患者（3%）在向上看的极端位置出现临床上无明显意义的术后复视。
通过正确选择最佳治疗方法，复视完全消失且眼球运动完全保留的比例在91%至97%之间。眼眶底骨折的手术治疗很重要，主要是为了尽量减少持续性创伤后复视，这种复视会显著降低患者的生活质量。
