Francomacaro Sara E, Bregman Jana A, Vakharia Kalpesh T, Grumbine Francis L
Department of Ophthalmology and Visual Sciences, University of Maryland Medical Center, Baltimore, MD, USA.
Department of Otorhinolaryngology, University of Maryland Medical Center, Baltimore, MD, USA.
Craniomaxillofac Trauma Reconstr. 2020 Sep;13(3):198-204. doi: 10.1177/1943387520922048. Epub 2020 Apr 30.
To determine the clinical utility of computed tomography (CT) imaging following isolated orbital blowout fracture (OBF) repair.
Single-center retrospective review of adult patients undergoing surgical repair of isolated OBFs between November 2008 and August 2016 who received postoperative CT scans. Preoperative and postoperative examination data, postoperative imaging reads, postoperative courses, and any reoperation documentation were collected from electronic medical records. Postoperative imaging findings were categorized as major, indeterminate, or minor by predicted impact on clinical management. Major findings indicated a need for reoperation, indeterminate a potential reoperation, and minor no reoperation.
Fifty-two cases met inclusion criteria: 94.2% (n = 49) of postoperative scans included minor findings, 34.6% (n = 18) indeterminate findings, and 19.2% (n = 10) major findings. Three patients returned to the operating room (OR) for surgical revision. All 3 had a significant and concerning change on postoperative examination. Only 1 also had a major finding on postoperative imaging. The remaining 49 patients had benign postoperative examinations, despite 9 (17.3%) with major imaging findings who did not undergo reoperation.
In the majority of OBF repairs, postoperative CT scan findings were not predictive of a need to return to the OR for revision. Reoperation was instead largely prompted by concerning changes in the postoperative clinical examination. Our findings suggest that postoperative imaging in the absence of clinical concern should not be included in the surgical management of isolated OBFs. Instead, targeted imaging will help reduce radiation exposure and health-care costs without sacrificing patient care.
确定单纯眼眶爆裂性骨折（OBF）修复术后计算机断层扫描（CT）成像的临床实用性。
对2008年11月至2016年8月期间接受单纯OBF手术修复并进行术后CT扫描的成年患者进行单中心回顾性研究。从电子病历中收集术前和术后检查数据、术后影像解读、术后病程以及任何再次手术记录。根据对临床管理的预测影响，将术后影像结果分为主要、不确定或次要。主要结果表明需要再次手术，不确定结果表示可能需要再次手术，次要结果表示无需再次手术。
52例符合纳入标准：94.2%（n = 49）的术后扫描显示次要结果，34.6%（n = 18）显示不确定结果，19.2%（n = 10）显示主要结果。3例患者返回手术室进行手术翻修。所有3例患者术后检查均有显著且令人担忧的变化。只有1例患者术后影像也显示主要结果。其余49例患者术后检查结果良好，尽管9例（17.3%）有主要影像结果但未进行再次手术。
在大多数OBF修复术中，术后CT扫描结果不能预测是否需要返回手术室进行翻修。相反，再次手术主要是由术后临床检查中令人担忧的变化引起的。我们的研究结果表明，在没有临床担忧的情况下，术后影像检查不应纳入单纯OBF的手术管理中。相反，有针对性的影像检查将有助于减少辐射暴露和医疗保健成本，同时不影响患者护理。
