From the Division of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center; the Department of Plastic and Reconstructive Surgery, Johns Hopkins University; and the Division of Plastic and Reconstructive Surgery, University of Maryland School of Medicine.
Plast Reconstr Surg. 2021 Jan 1;147(1):82e-93e. doi: 10.1097/PRS.0000000000007436.
Fractures of the orbital roof require high-energy trauma and have been linked to high rates of neurologic and ocular complications. However, there is a paucity of literature exploring the association between injury, management, and visual prognosis.
The authors performed a 3-year retrospective review of orbital roof fracture admissions to a Level I trauma center. Fracture displacement, comminution, and frontobasal type were ascertained from computed tomographic images. Pretreatment characteristics of operative orbital roof fractures were compared to those of nonoperative fractures. Risk factors for ophthalmologic complications were assessed using univariable/multivariable regression analyses.
In total, 225 patients fulfilled the inclusion criteria. Fractures were most commonly nondisplaced [n = 118 (52.4 percent)] and/or of type II frontobasal pattern (linear vault involving) [n = 100 (48.5 percent)]. Eight patients underwent open reduction and internal fixation of their orbital roof fractures (14.0 percent of displaced fractures). All repairs took place within 10 days from injury. Traumatic optic neuropathy [n = 19 (12.3 percent)] and retrobulbar hematoma [n = 11 (7.1 percent)] were the most common ophthalmologic complications, and led to long-term visual impairment in 51.6 percent of cases.
Most orbital roof fractures can be managed conservatively, with no patients in this cohort incurring long-term fracture-related complications or returning for secondary treatment. Early fracture treatment is safe and may be beneficial in patients with vertical dysmotility, globe malposition, and/or a defect surface area larger than 4 cm2. Ophthalmologic prognosis is generally favorable; however, traumatic optic neuropathy is major cause of worse visual outcome in this population.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
眼眶顶骨折需要高能量创伤，并与高比例的神经和眼部并发症相关。然而，探索损伤、处理和视觉预后之间关系的文献却很少。
作者对一家一级创伤中心的眼眶顶骨折住院患者进行了为期 3 年的回顾性研究。从 CT 图像中确定骨折移位、粉碎和额底类型。比较手术治疗的眼眶顶骨折的术前特征与非手术治疗的骨折。使用单变量/多变量回归分析评估眼科并发症的危险因素。
共有 225 名患者符合纳入标准。骨折最常见的是无移位[n = 118（52.4％）]和/或 II 型额底型（线性穹顶累及）[n = 100（48.5％）]。8 名患者接受了眼眶顶骨折的切开复位和内固定（14.0％的移位骨折）。所有修复均在受伤后 10 天内进行。外伤性视神经病变[n = 19（12.3％）]和眶内血肿[n = 11（7.1％）]是最常见的眼部并发症，导致 51.6％的病例出现长期视力损害。
大多数眼眶顶骨折可以保守治疗，本队列中没有患者发生长期与骨折相关的并发症或需要再次治疗。早期骨折治疗是安全的，对于垂直运动障碍、眼球位置不正和/或缺陷表面积大于 4 cm2 的患者可能有益。眼科预后通常较好；然而，外伤性视神经病变是该人群视力预后较差的主要原因。
临床问题/证据水平：风险，III。
