Ambat Jose Miguel, Takahashi Yasuhiro
Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, 1-1 Yazako-Karimata, Nagakute, Aichi, 480-1195, Japan.
Graefes Arch Clin Exp Ophthalmol. 2025 Jan 9. doi: 10.1007/s00417-024-06734-0.
To define the anatomical variance between orbital floor and medial orbital wall blowout fractures, and its change with age.
This was a retrospective, observational study analyzing data from 557 patients with isolated blowout fractures of the orbital floor or medial orbital wall. Axial and quasi-sagittal CT images were analyzed to compare radiologic data on orbital wall morphology between fracture site groups and among age groups. Patient ages were classified as: 0-9 (childhood), 10-18 (adolescence), 19-44 (early adulthood), 45-64 (middle adulthood), and ≥ 65 years (late adulthood).
The orbital floor fracture group demonstrated significantly steeper orbital floors (p < 0.001), while the medial wall fracture group exhibited a tendency for more convex medial orbital walls (p = 0.066). Among age groups, medial wall fracture was predominant in the late adulthood group only (p < 0.001). Patients in the childhood and late adulthood groups had significantly flatter orbital floors (p < 0.001). Patients in the childhood group presented with a concave medial orbital wall (p < 0.001). The anteroposterior length of the medial orbital wall and the number of ethmoid air cells were not different between fracture groups (p = 0.603 and 0.753, respectively) and among age groups (p = 0.306 and 0.456, respectively).
Patients with orbital floor and medial orbital wall fractures had anatomically steeper orbital floors and convex medial orbital walls, respectively. Age-related differences in the shape of the orbital walls may influence variation in orbital blowout fracture sites by age.
WHAT IS KNOWN : Fracture sites of the orbital walls differ according to age groups. The floor is more commonly fractured in children, with a shift to the medial wall in the elderly.
Orbital floor and medial orbital wall fractures present with anatomically higher floor and medial walls, respectively, compared to each other. This indicates steeper convexities of the walls which predispose them to fracturing. Children's medial orbital walls are initially concave, then shift to convex structures with facial bone and sinus maturation. This explains why there is a change in blowout fracture site between age groups, as it has been documented that concave structures are more resistant to deformation.
明确眶底和眶内侧壁爆裂性骨折之间的解剖学差异及其随年龄的变化。
这是一项回顾性观察研究，分析了557例孤立性眶底或眶内侧壁爆裂性骨折患者的数据。分析轴向和准矢状面CT图像，以比较骨折部位组之间以及年龄组之间眶壁形态的放射学数据。患者年龄分为：0 - 9岁（儿童期）、10 - 18岁（青少年期）、19 - 44岁（成年早期）、45 - 64岁（成年中期）和≥65岁（成年晚期）。
眶底骨折组的眶底明显更陡峭（p < 0.001），而眶内侧壁骨折组的眶内侧壁有更凸出的趋势（p = 0.066）。在各年龄组中，仅成年晚期组眶内侧壁骨折占主导（p < 0.001）。儿童期和成年晚期组的患者眶底明显更平坦（p < 0.001）。儿童期组的患者眶内侧壁呈凹陷状（p < 0.001）。眶内侧壁的前后长度和筛窦气房数量在骨折组之间（分别为p = 0.603和0.753）以及年龄组之间（分别为p = 0.306和0.456）无差异。
眶底和眶内侧壁骨折患者分别具有解剖学上更陡峭的眶底和凸出的眶内侧壁。眶壁形状的年龄相关差异可能影响不同年龄段眶爆裂性骨折部位的变化。
已知情况：眶壁骨折部位因年龄组而异。儿童期眶底骨折更常见，老年期则转向眶内侧壁骨折。
与彼此相比而言，眶底和眶内侧壁骨折分别呈现出解剖学上更高的眶底和眶内侧壁。这表明眶壁的凸度更大，使其更容易发生骨折。儿童的眶内侧壁最初是凹陷的，然后随着面骨和鼻窦成熟转变为凸出结构。这解释了不同年龄组之间爆裂性骨折部位的变化，因为有记录表明凹陷结构更抗变形。
