Department of Ophthalmology, Brooke Army Medical Center, San Antonio, Texas.
Department of Surgery, Uniformed Services University of the Health Science, Bethesda, Maryland.
Ophthalmic Plast Reconstr Surg. 2020 Jan/Feb;36(1):55-60. doi: 10.1097/IOP.0000000000001461.
To update the incidence of orbital fractures in U.S. Soldiers admitted to the former Walter Reed Army Medical Center from 2001 to 2011 after sustaining combat injuries in Operation Iraqi Freedom and Operation Enduring Freedom.
Data were collected in the Walter Reed Ocular Trauma Database. Inclusion criteria were any U.S. Soldier or Department of Defense civilian with an orbital fracture injured in Operation Iraqi Freedom/Operation Enduring Freedom. Primary outcome measures were final visual acuity and the effect of orbital fracture, number of fractures, and anatomic location of fracture on final visual acuity.
Eight-hundred ninety eye injuries occurred in 652 patients evacuated to Walter Reed Army Medical Center between 2001 and 2011. Orbital fractures occurred in 304 eyes (34.2%). A single wall was fractured in 140 eyes (46.05%), 2 in 99 (32.6%) eyes, 3 in 31 (10.2%), 4 in 28 (9.2%), and unknown in 6 (1.9%) eyes. Roof fractures were found in 74 (24.34%), medial wall in 135 (44.41%), lateral wall in 109 (35.9%), and floor fractures in 217 (71.4%). Final visual acuity was analyzed and 140 (46.05%) eyes had greater than 20/40 vision, 17 (5.59%) were 20/50 to 20/200, 26 (8.5%) were count fingers to light perception, and 95 (31.3%) were no light perception. In logistic regression analysis, roof (p = 0.001), medial (p = 0.009), and lateral fractures (p = 0.016) were significantly associated with final visual acuity less than 20/200, while floor fractures were not (p = 0.874). Orbital fracture and all fracture subtypes were significantly associated with traumatic brain injury, retrobulbar hematoma, optic nerve injury, but not for vitreous hemorrhage, commotio, hyphema, and choroidal rupture. Fracture repair was noted in 45 (14.8%).
Orbital fractures occurred in a third of Operation Iraqi Freedom/Operation Enduring Freedom eyes of ocular trauma patients referred to one tertiary care military hospital. This resulted in approximately 40% of these eyes remaining legally blind after injury.Orbital fractures occur commonly during combat trauma and a significant number are legally blind despite appropriate treatment.
更新 2001 年至 2011 年期间，在伊拉克自由行动和持久自由行动中遭受战斗伤害后，被送往前沃尔特·里德陆军医疗中心的美国士兵的眼眶骨折发生率。
数据收集于沃尔特·里德眼部创伤数据库。纳入标准为任何在伊拉克自由行动/持久自由行动中受伤的美国士兵或国防部文职人员，患有眼眶骨折。主要结局指标为最终视力和眼眶骨折、骨折数量以及骨折解剖位置对最终视力的影响。
2001 年至 2011 年间，有 890 例眼部损伤患者被送往沃尔特·里德陆军医疗中心，其中 652 例患者发生眼眶骨折。304 只眼（34.2%）发生眼眶骨折。140 只眼（46.05%）单一壁骨折，99 只眼（32.6%）两处骨折，31 只眼（10.2%）三处骨折，28 只眼（9.2%）四处骨折，6 只眼（1.9%）骨折部位不明。74 只眼（24.34%）发现颅顶骨折，135 只眼（44.41%）发现内侧壁骨折，109 只眼（35.9%）发现外侧壁骨折，217 只眼（71.4%）发现底壁骨折。分析最终视力，140 只眼（46.05%）视力大于 20/40，17 只眼（5.59%）视力为 20/50 至 20/200，26 只眼（8.5%）视力为手动至光感，95 只眼（31.3%）无光感。在逻辑回归分析中，颅顶（p = 0.001）、内侧（p = 0.009）和外侧骨折（p = 0.016）与视力小于 20/200 显著相关，而底壁骨折则无显著相关性（p = 0.874）。眼眶骨折和所有骨折亚型均与创伤性脑损伤、眶后血肿、视神经损伤显著相关，但与玻璃体出血、震荡伤、前房积血和脉络膜破裂无关。45 例（14.8%）进行了骨折修复。
在一家三级护理军事医院转诊的眼部创伤患者中，约有三分之一的伊拉克自由行动/持久自由行动眼发生眼眶骨折。这导致这些眼在受伤后约有 40%仍处于法定盲状态。眼眶骨折在战斗创伤中很常见，尽管进行了适当的治疗，仍有相当数量的眼处于法定盲状态。
