眼眶下壁爆裂性骨折患者保守治疗后发生眼球内陷的影响因素  

Influencing factors of enophthalmos after conservative treatment of inferior orbital wall blow-out fractures

作　　者：靳玮 李谦 柴昌 JIN Wei;LI Qian;CHAI Chang(Henan Provincial People's Hospital,Henan Eye Hospital,Henan Eye Institute,Zhengzhou University People'sHospital,Zhengzhou,Henan 450003,China)

机构地区：[1]河南省人民医院、河南省立眼科医院、河南省眼科研究所郑州大学人民医院,河南郑州450003

出　　处：《中华实用诊断与治疗杂志》2022年第11期1153-1156,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省自然科学基金(202300410406)。

摘　　要：目的 观察眼眶下壁爆裂性骨折患者保守治疗后眼球内陷发生情况,探讨其发生的影响因素。方法 单眼眼眶下壁爆裂性骨折患者94例,均给予冷敷或热敷观察随诊或静脉应用糖皮质激素保守治疗。创伤后3个月,发生眼球内陷(双眼眼球突出度差>2 mm)28例为内陷组,未发生眼球内陷66例为非内陷组。比较2组致伤原因,治疗前眶壁缺损面积、眶壁缺损冠状及矢状径、患眼及健眼下直肌高宽比、静脉应用糖皮质激素>3 d比率等;采用多因素logistic回归分析眼眶下壁爆裂性骨折患者保守治疗后发生眼球内陷的影响因素;绘制ROC曲线,评估治疗前患眼下直肌高宽比预测眼眶下壁爆裂性骨折患者保守治疗后发生眼球内陷的效能。结果 内陷组眶壁缺损矢状径[15.7(13.0,17.5)mm]大于非内陷组[14.3(8.0,17.5)mm](Z=2.268,P=0.023),患眼下直肌高宽比(0.70±0.06)、静脉应用糖皮质激素>3 d比率(25.0%)均高于非内陷组(0.62±0.07,9.1%)(t=5.280,P<0.001;χ^(2)=4.175,P=0.041),2组性别比例,年龄,体质量指数,致伤原因,治疗前眶壁缺损面积、眶壁缺损冠状径、健眼下直肌高宽比比较差异均无统计学意义(P>0.05)。治疗前患眼下直肌高宽比(OR=1.219,95%CI:1.110~1.339,P<0.001)、静脉应用糖皮质激素>3 d(OR=4.719,95%CI:1.105~20.149,P=0.036)是眼眶下壁爆裂性骨折患者保守治疗后发生眼球内陷的影响因素。治疗前患眼下直肌高宽比以0.685为最佳截断值,预测眼眶下壁爆裂性骨折患者保守治疗后发生眼球内陷的AUC为0.808(95%CI:0.715~0.900,P<0.001),灵敏度为71.4%,特异度为83.3%。结论 眼眶下壁爆裂性骨折患者治疗前患眼下直肌高宽比及应用糖皮质激素是保守治疗后发生眼球内陷的影响因素,患眼下直肌高宽比对预测其保守治疗后发生眼球内陷有较高价值。Objective To observe the occurrence of enophthalmos in patients with inferior orbital wall blow-out fractures after conservative treatment,and to investigate its influencing factors.Methods Ninety-four patients with unilateral inferior orbital wall blow-out fracture received conservative treatment as cold compress,hot compress or intravenous glucocortitoid.According to the enophthalmos occurred or not 3 months after fracture,94 patients were divided into enophthalmos group(n=28)and non-enophthalmos group(n=66).The cause of fracture,defect area of the orbital floor before treatment,coronal diameter of the defect area,sagittal diameter of the defect area,rounding of the inferior rectus muscle,and percentage of patients receiving intravenous glucocorticoid over 3 days were compared between two groups.Multivariate logistic regression analysis was used to explore the risk factors of enophthalmos after conservative treatment.ROC curves were drawn to evaluate the predictive efficiency of rounding of the inferior rectus muscle.Results The sagittal diameter of the defect area was greater in enophthalmos group[15.7(13.0,17.5)mm]than that in non-enophthalmos group[14.3(8.0,17.5)mm](Z=2.268,P=0.023),the rounding of the inferior rectus muscle and percentage of patients receiving intravenous glucocorticoid over 3 days were higher in enophthalmos group(0.70±0.06,25.0%)than those in non-enophthalmos group(0.62±0.07,9.1%)(t=5.280,P<0.001;χ^(2)=4.175,P=0.041),and there were no significant differences in the gender ratio,age,body mass index,cause of fracture,defect area of the orbital floor before treatment,coronal diameter of the defect area,and rounding of the inferior rectus muscle of the normal eye between two groups(P>0.05).The rounding of the inferior rectus muscle of the diseased eye(OR=1.219,95%CI:1.110-1.339,P<0.001)and the use of intravenous glucocorticoid over 3 days (OR=4.719,95%CI:1.105-20.149,P=0.036)were the influencing factors of enophthalmos.When the optimal cut-offvalue of the rounding of the inferior rectus mu

关 键 词：眼眶骨折 爆裂性骨折 眼眶下壁 眼球内陷 下直肌高宽比 

分 类 号：R779.6[医药卫生—眼科]