眶容积改变在筛骨垂直板眶内壁骨折重建术效果评估中的应用

Application of orbital volume change in the evaluation of curative effect reconstruction of ethmoid vertical plate orbital wall fracture

目的探讨眼眶容积变化在鼻内窥镜下筛骨垂直板眶内壁重建手术效果评估中的应用。方法回顾性病例系列研究。分析安徽医科大学第三附属医院2018年2月至2022年1月使用自体筛骨垂直板进行眶壁骨折手术修复的眼外伤22例双眼的临床资料,分别于术前及术后6个月观察患者最佳矫正视力、复视、眼球运动障碍等改善情况,同时记录CT影像学融合容积测量软件下双侧眼眶容积测量值,对比分析手术效果。结果22例患者术后最佳矫正视力及眼球运动受限较前改善;术后6个月复视程度较术前明显好转(术前复视程度为0、Ⅰ、Ⅱ、Ⅲ、Ⅳ级分别有11、2、5、4、0只眼,术后复视程度为0、Ⅰ、Ⅱ、Ⅲ、Ⅳ级分别有21、1、0、0、0只眼);术后6个月患眼突出度(17.0±0.26)mm较术前(14.4±0.56)mm显著提高(t=26.37,P<0.001);术前患眼容积(33.98±0.93)ml较健眼(29.95±0.36)ml显著增加(t=19.91,P<0.001);术后6个月患眼容积(30.21±0.76)ml较术前患眼(33.98±0.93)ml显著降低(t=-19.91,P<0.001);术后患眼容积(30.21±0.76)ml与健眼(29.96±0.36)ml相比较差异无统计学意义(t=1.28,P=0.213)。结论应用影像学技术及相关软件测量筛骨垂直板眶内壁骨折重建术后眼眶容积较术前降低,"定量"评估手术通过松解眼眶骨折区域嵌顿的软组织完成骨折整复的效果。

Objective To explore the application of orbital volume change in the evaluation of the curative efficacy of orbital reconstruction with ethmoid vertical plate under nasal endoscope.Methods This was a retrospective case series study.The clinical data of 22 binocular ocular trauma patients Hefei First People’s Hospital,who underwent surgical repair of orbital wall fracture with vertical plate of autogenous ethmoid bone in the Third Affiliated hospital of Anhui Medical University from Feb.2018 to Jan.2022 were analyzed.The changes of best corrected visual acuity(BCVA),diplopia and eye movement disorders were observed before and 6 months after surgery,and the measured values of bilateral orbital volume under the CT imaging fusion volume measurement software were recorded,the surgical efficacy was analyzed by comparison.Results The best corrected vision and eye movement limitation of 22 patients were improved after operation.The degree of diplopia was significantly improved at 6 months after operation.The preoperative diplopia degree was 0,Ⅰ,Ⅱ,Ⅲ,and Ivin 11,2,5,4,and 0 eyes,while the degree of diplopia at 3 months after surgery was 0,Ⅰ,Ⅱ,Ⅲ,andⅣin 21,1,0,0,0,and 0 eyes,respectively.The exophthalmos of the affected eye(17.0±0.26)mm was significantly higher than that of the affected eye(14.4±0.56)mm at 6 months after operation(t=26.37,P<0.001).The volume of the affected eye before operation(33.98±0.93)ml was significantly higher than that of the healthy eye(29.95±0.36)ml(t=19.91,P<0.001).The volume of the affected eye(30.21±0.76)ml at 6 months after operation was significantly lower than that of the affected eye(33.98±0.93)ml before operation(t=-19.91,P<0.001).The volume of the affected eye(30.21±0.76)ml after operation was not significantly different from that of the healthy eye(29.96±0.36)ml(t=1.28,P=0.213).Conclusion Using imaging technology and related software to measure the orbital volume after reconstruction of the orbital wall fracture with the vertical plate of the ethmoid bone is lower than that before the operation,and it can"quantitatively"evaluate the effect of fracture reduction by loosening the soft tissue embedded in the orbital fracture area.