Head, Division of Oral and Maxillofacial Surgery, Department of Surgery, Faculty of Medicine, University of Geneva & University Hospitals of Geneva, Geneva, Switzerland.
J Plast Reconstr Aesthet Surg. 2022 Jul;75(7):2268-2276. doi: 10.1016/j.bjps.2022.04.034. Epub 2022 Apr 25.
The management of blow-out orbital fractures (BOFs) continues to be controversial and regularly questioned. In recent years, treatment decision-making has shifted from a clinically dominated emphasis to a more objective data-based approach. This has come about through the refinement of imaging technologies that can more precisely define the fracture itself. Decision-making is now mainly driven by computed tomography (CT) parameters among which the fracture's size is by far the most often used. The variability in a patient's clinical presentation and outcomes for similar types of BOFs raises serious doubts about the pertinence of applying standardized guidelines based on quantitative data for the treatment of individual patients. An approach that fails to include patient variability and relies too heavily on average objective results with an emphasis on the application of quantitative rather than qualitative methods can lead to poor patient outcomes. A review of the knowledge accumulated over the many years of treatment of BOFs has demonstrated that despite the exceptional imaging-based technologies available, clinical acumen remains the most sophisticated decision-assistive tool. Thus, the treatment of BOFs must be regarded as a patient rather than merely a geometrical imaging issue. Imaging then becomes a valuable diagnostic rather than a final decision-making tool. This more conservative approach leads to a substantial decrease in indications for surgical repair.
爆裂性眼眶骨折（BOF）的治疗仍然存在争议，经常受到质疑。近年来，治疗决策已从以临床为主导的方法转变为更客观的基于数据的方法。这是通过改进成像技术实现的，这些技术可以更精确地定义骨折本身。决策现在主要由计算机断层扫描（CT）参数驱动，其中骨折的大小是迄今为止最常用的参数。对于类似类型的 BOF，患者临床表现和结果的可变性对基于定量数据为个别患者制定标准化治疗指南的相关性提出了严重质疑。一种不包括患者变异性且过于依赖平均客观结果、强调应用定量而非定性方法的方法可能导致患者预后不佳。对多年来 BOF 治疗积累的知识进行回顾表明，尽管存在出色的基于成像的技术，但临床敏锐度仍然是最复杂的决策辅助工具。因此，BOF 的治疗必须被视为患者问题，而不仅仅是几何成像问题。成像因此成为有价值的诊断工具，而不是最终的决策工具。这种更保守的方法导致手术修复的适应证大大减少。
