Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, Severance Hospital.
Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul.
J Craniofac Surg. 2023 Jun 1;34(4):1185-1190. doi: 10.1097/SCS.0000000000009152. Epub 2023 Jan 19.
Enophthalmos is one of the most distressing complications of blowout orbital fractures. Although several studies have been conducted on the topic of indications of early surgical correction, none have been performed using a set of measurable parameters.
The study quantitatively examined orbital fracture areas (OFA) and volumes (OFV) retrospectively of 242 patients with isolated medial orbital wall fractures that were treated conservatively during a 12-year period (from 2009 to 2021). Three plastic surgeons measured enophthalmos >6 months after trauma. The correlations between parameters and enophthalmos in the study cohort were analyzed. In addition, patients treated operatively, and nonoperatively were compared with assess the suitability of the predictive model.
Significant correlations were observed between several parameters and late enophthalmos. Total 2.59 cm 2 of OFA (ie, OFA >2.59 cm 2 ) or 1.45 cm 3 of OFV (ie, OFV >1.45 cm 3 ) corresponds to 2 mm of enophthalmos. Multiple regression analysis revealed the following coefficients: -0.208 is a constant ( P <0.001), with 0.695 and 0.372 for OFA and OFV, respectively ( P <0.001 for both OFA and OFV).
The study shows that enophthalmos can be more accurately predicted when OFA and OFV are simultaneously considered in patients with isolated medial wall fractures. Finally, an algorithm and a "blowout fracture coordinate plane" was proposed to aid treatment decision-making in isolated medial wall fractures.
眼球内陷是爆裂性眼眶骨折最令人痛苦的并发症之一。尽管已经有几项关于早期手术矫正适应证的研究，但都没有使用一套可测量的参数进行研究。
本研究对 242 例单纯内侧眶壁骨折患者的眼眶骨折面积（OFA）和体积（OFV）进行了回顾性定量研究，这些患者在 12 年期间（2009 年至 2021 年）接受了保守治疗。3 位整形外科医生测量了外伤后超过 6 个月的眼球内陷程度。分析了研究队列中参数与眼球内陷的相关性。此外，还比较了手术和非手术治疗的患者，以评估预测模型的适用性。
观察到几个参数与晚期眼球内陷之间存在显著相关性。OFA 总量为 2.59cm 2（即 OFA>2.59cm 2）或 OFV 为 1.45cm 3（即 OFV>1.45cm 3），分别对应 2mm 的眼球内陷。多元回归分析显示以下系数：常数-0.208（ P <0.001），OFA 和 OFV 分别为 0.695 和 0.372（两者均 P <0.001）。
本研究表明，在考虑单纯内侧壁骨折患者的 OFA 和 OFV 时，眼球内陷可以更准确地预测。最后，提出了一种算法和“爆裂性骨折坐标平面”，以帮助治疗决策孤立性内侧壁骨折。
