Department of Oral and Craniomaxillofacial Plastic Surgery, UKGM GmbH, University Hospital Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg 35043, Germany.
Faculty of Medicine, Goethe University, Frankfurt am Main, Germany.
J Stomatol Oral Maxillofac Surg. 2023 Feb;124(1):101267. doi: 10.1016/j.jormas.2022.08.010. Epub 2022 Aug 18.
To evaluate clinical usefulness of endoscope-assisted medial orbital wall fracture repair via the retrocaruncular approach (rc-EAMOWFR) vs. no surgery (NS), and to perform a narrative review of relevant literature.
This was a retrospective cohort study enrolling isolated medial orbital wall fracture (IMOWF) eyes presented to two German level 1 trauma centers during a 7-year interval. The predictor variable was treatment type (rc-EAMOWFR vs. NS), and the main outcomes were late enophthalmos (LE) and retrobulbar hemorrhage (RH) assessed at 9-15 posttraumatic months. Descriptive and bivariate statistics were computed at α = 95%. Binary adjustments enabled calculation of number needed to treat (NNT), to harm (NNH), and likelihood to be helped or harmed (LHH) for demonstrating benefit-risk tradeoffs. Moreover, a narrative review was also performed.
The sample comprised 502 patients (28.3% females; mean age, 46.5±19.2 years) with 541 IMOWF eyes (5.9% NS; 7.2% LE; 1.3% RH). Operated eyes had significantly lower LE events than NS eyes (symptomatic IMOWF: P < .0001; 95% confidence interval [CI], .03 to .16; NNT = 2 [95% CI, 1.1 to 6.1]; asymptomatic IMOWF: P < .0001; 95% CI, .01 to .07; NNT = 2 [95% CI, 1.1 to 1.8]). There were 7 (1.5%) RH events following rc-EAMOWFR (P = .99; 95% CI, .06 to 17.4; NNH = 68 [95% CI, 38.3 to 254.2]). LHH calculations posited that rc-EAMOWFR was 34 times more likely to prevent LE than to cause RH, regardless of fracture symptoms. Our results conformed to those of other 15 studies.
The results of this study suggest that all IMOWFs be treated. rc-EAMOWFR performed in every 68 IMOWFs would be at risk of one RH event, but prevent 34 eyes from LE due to untreated fractures. Nearly 72% of untreated IMOWFs develop LE after 9 months.
通过经滑车内侧眶壁骨折修复的后径路（rc-EAMOWFR）评估与非手术（NS）相比的临床实用性，并对相关文献进行叙述性综述。
这是一项回顾性队列研究，纳入了在 7 年期间在两家德国 1 级创伤中心就诊的孤立性内侧眶壁骨折（IMOWF）眼。预测变量是治疗类型（rc-EAMOWFR 与 NS），主要结局是在创伤后 9-15 个月评估的晚期眼球内陷（LE）和球后血肿（RH）。α=95%时计算描述性和双变量统计数据。二元调整可计算出需要治疗的数量（NNT）、需要治疗的数量（NNH）和获益或受损的可能性（LHH），以证明获益风险的权衡。此外，还进行了叙述性综述。
该样本包括 502 名患者（28.3%为女性；平均年龄 46.5±19.2 岁），共 541 只 IMOWF 眼（5.9%为 NS；7.2%为 LE；1.3%为 RH）。手术眼的 LE 事件明显低于 NS 眼（有症状的 IMOWF：P<.0001；95%置信区间[CI]，0.03 至 0.16；NNT=2[95%CI，1.1 至 6.1]；无症状的 IMOWF：P<.0001；95%CI，0.01 至 0.07；NNT=2[95%CI，1.1 至 1.8]）。rc-EAMOWFR 后发生 7 例（1.5%）RH 事件（P=.99；95%CI，0.06 至 17.4；NNH=68[95%CI，38.3 至 254.2]）。LHH 计算表明，rc-EAMOWFR 预防 LE 的可能性是导致 RH 的 34 倍，而与骨折症状无关。我们的结果与其他 15 项研究一致。
这项研究的结果表明，所有 IMOWF 都应进行治疗。每 68 例 IMOWF 中进行 1 例 rc-EAMOWFR 手术，就有 1 例发生 RH 事件的风险，但可预防 34 例因未治疗的骨折而导致的 LE。近 72%的未治疗的 IMOWF 在 9 个月后会发生 LE。
