Raskin E M, Millman A L, Lubkin V, della Rocca R C, Lisman R D, Maher E A
Department of Ophthalmology, New York Eye and Ear Infirmary, New York, USA.
Ophthalmic Plast Reconstr Surg. 1998 Jan;14(1):19-26. doi: 10.1097/00002341-199801000-00006.
The purpose of this study was to determine whether orbital volume assessment by computerized tomography (CT) could provide additional information for the initial evaluation of orbital blowout fractures and guide optimal treatment. The medical records of 30 patients with orbital blowout fractures, either surgically or conservatively managed, were retrospectively reviewed. Orbital volumetric analysis was then determined from digitized CT scans. Fracture-related volume expansion relative to the unaffected fellow orbit was correlated with motility deficits and location and degree of enophthalmos. Early Hertel's measurements (< 4 weeks) were available in 21 patients and did not correlate with the computer volumetric values or with subsequent late enophthalmos. Late Hertel's measurements (> 4 weeks) were obtained in 13 of 15 nonrepaired fractures and in 5 of 15 surgically repaired patients (late presentation; 18 patients). When seen at more than 4 weeks, 11 (92%) of 12 patients with > or = 13% orbital volume expansion manifested significant enophthalmos (> 2 mm) compared with 1 (17%) of 6 patients with < 13% orbital expansion (p = 0.004). Fractures presenting with enophthalmos on initial examination had extensive medial wall involvement in addition to the floor fracture (p = 0.003). CT measurements of orbital volume can predict the final degree of late enophthalmos and may facilitate the planning of surgical intervention.
本研究的目的是确定通过计算机断层扫描（CT）评估眼眶容积是否可为眼眶爆裂性骨折的初始评估提供额外信息，并指导最佳治疗。对30例接受手术或保守治疗的眼眶爆裂性骨折患者的病历进行了回顾性研究。然后通过数字化CT扫描确定眼眶容积分析。相对于未受影响的对侧眼眶，与骨折相关的容积增加与眼球运动障碍以及眼球内陷的位置和程度相关。21例患者可获得早期（<4周）的赫特尔测量值，其与计算机容积值或随后的晚期眼球内陷均无相关性。15例未修复骨折中的13例以及15例手术修复患者中的5例（延迟就诊；共18例患者）获得了晚期（>4周）的赫特尔测量值。在4周以上就诊时，眼眶容积扩大≥13%的12例患者中有11例（92%）出现明显眼球内陷（>2mm），而眼眶容积扩大<13%的6例患者中有1例（17%）出现明显眼球内陷（p=0.004）。初始检查时出现眼球内陷的骨折除眶底骨折外，还伴有广泛的眶内壁受累（p=0.003）。CT测量眼眶容积可预测晚期眼球内陷的最终程度，并可能有助于手术干预的规划。
