Causbie Jacqueline, Walters Benjamin, Lally John, Adams Jason, Aden James, Bevans Scott, Spear Samuel, Robitschek Jon
Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
San Antonio Military Medical Center, Ft. Sam Houston, Texas, USA.
Facial Plast Surg Aesthet Med. 2020 May 14. doi: 10.1089/fpsam.2020.0117.
Orbital floor fracture repair is complex and postoperative complications are common. A variety of applicable surgical techniques and technologies are available to surgeons, so data about which of these may decrease postoperative complication rates can help better guide clinical decision making. : To characterize the patient demographics and surgical techniques utilized in orbital floor fracture repairs at San Antonio Military Medical Center and their relationship with rates of postoperative complications. Retrospective chart review of patients who underwent orbital floor fracture repairs from March 2014 to March 2019 with a mean follow-up time of 1.86 months at a tertiary care academic military hospital and level 1 trauma center. Demographic data, indication for surgical repair, fracture severity, orbital floor approach, implant material, and use of intraoperative computed tomography (CT) scan were recorded. Chi-square analysis was performed to determine the relationship between these factors and postoperative diplopia, hypoglobus, enophthalmos, and infection. A total of 124 procedures were performed during the study period: 71.8% of patients were male and 74% were civilian. Mean age was 39 years (range 19-81). Thirty-one patients were lost to follow-up. The most common approach was transconjunctival (83%), which was most frequently used exclusively (68.5%), but was also combined with cantholysis, transcaruncular, or transantral approach. Postoperative diplopia at follow-up was common (53.8%), resolved after an average of 36.3 days, and was significantly associated with surgical indication of entrapment or revision ( = 0.01) and nonutilization of intraoperative CT ( = 0.04). From 2014 to 2016, intraoperative CT was utilized in 21% of cases and revision rate was 10.5%. From 2017 to 2019, 50% of cases utilized intraoperative CT and revision rate was 2% ( = 0.15). Three cases were revisions performed for abnormal plate position noted on postoperative CT scan. A statistically significant association was found between postoperative diplopia, surgical indication of entrapment or revision, and nonutilization of intraoperative CT. Revision rates decreased when use of intraoperative CT increased. Three revision cases may have been prevented by use of an intraoperative CT scan. Patients with entrapment should be counseled regarding the increased risk of postoperative diplopia.
眼眶底骨折修复手术复杂，术后并发症常见。外科医生可采用多种适用的手术技术和方法，因此有关哪种技术可能降低术后并发症发生率的数据有助于更好地指导临床决策。目的：描述圣安东尼奥军事医疗中心眼眶底骨折修复手术中患者的人口统计学特征和所采用的手术技术，以及它们与术后并发症发生率的关系。对2014年3月至2019年3月在一家三级医疗学术军事医院及一级创伤中心接受眼眶底骨折修复手术的患者进行回顾性病历审查，平均随访时间为1.86个月。记录人口统计学数据、手术修复指征、骨折严重程度、眼眶底入路、植入材料以及术中计算机断层扫描（CT）的使用情况。采用卡方分析确定这些因素与术后复视、眼球下转、眼球内陷和感染之间的关系。研究期间共进行了124例手术：71.8%的患者为男性，74%为平民。平均年龄为39岁（范围19 - 81岁）。31例患者失访。最常见的入路是经结膜入路（83%），最常单独使用（68.5%），但也与眦切开术、经泪阜或经鼻窦入路联合使用。随访时术后复视常见（53.8%），平均36.3天后缓解，且与眼球嵌顿或翻修的手术指征（P = 0.01）以及未使用术中CT（P = 0.04）显著相关。2014年至2016年，21%的病例使用了术中CT，翻修率为10.5%。2017年至2019年，50%的病例使用了术中CT，翻修率为2%（P = 0.15）。有3例因术后CT扫描发现钢板位置异常而进行翻修。术后复视、眼球嵌顿或翻修的手术指征以及未使用术中CT之间存在统计学显著关联。术中CT使用增加时，翻修率降低。使用术中CT扫描可能避免了3例翻修病例。对于眼球嵌顿的患者，应告知其术后复视风险增加。
