Smith B, Lisman R D, Simonton J, Della Rocca R
Plast Reconstr Surg. 1984 Aug;74(2):200-16. doi: 10.1097/00006534-198408000-00004.
In the past decade there has been considerable controversy over the surgical indications for treatment of blowout fractures of the orbit. It has been well recognized that some fracture patients develop an ischemic contracture of the inferior rectus muscle. We have found that a Volkmann's type of contracture of the inferior rectus muscle does exist and is similar to that found in the distal extremities. A specific group of fracture patients is at greater risk for development of a contracture. Elderly patients, hypotensive patients, patients with small fractures, and those with high inferior rectus compartment pressures are more prone to developing a contracted extraocular muscle. We have measured compartment pressures in 18 patients who were surgical candidates following orbital fracture. Our conclusions indicate that surgical intervention following blowout fractures in these high-risk patients may be more prudent than medical management. Patients with persistent diplopia due to a contracted inferior rectus are extremely difficult to treat many months after fracture. We still believe it prudent to surgically repair orbital fractures in patients with diplopia, enophthalmos, and a risk for muscle contracture. The documentation of this additional sequela of unrepaired fractures lends more strength to this belief. There is no evidence to indicate that a Volkmann's contracture would be possible after early repair of a blowout fracture.
在过去十年中，关于眼眶爆裂性骨折的手术治疗指征存在相当大的争议。人们已经充分认识到，一些骨折患者会出现下直肌缺血性挛缩。我们发现，下直肌确实存在Volkmann氏型挛缩，且与在四肢远端发现的情况相似。特定的一组骨折患者发生挛缩的风险更高。老年患者、低血压患者、骨折较小的患者以及下直肌间隙压力高的患者更容易出现眼外肌挛缩。我们测量了18例眼眶骨折后拟行手术治疗患者的间隙压力。我们的结论表明，对这些高危患者的爆裂性骨折进行手术干预可能比保守治疗更为审慎。骨折数月后，因下直肌挛缩导致持续性复视的患者极难治疗。我们仍然认为，对于有复视、眼球内陷以及肌肉挛缩风险的患者，手术修复眼眶骨折是审慎的做法。未修复骨折这一额外后遗症的记录为这一观点提供了更多依据。没有证据表明爆裂性骨折早期修复后会发生Volkmann氏挛缩。
