眶底爆裂性骨折修复术后持续性复视相关因素分析  

Associated factors of persistent diplopia after orbital floor blowout fracture reconstruction

作　　者：郑嵩山 柴昌 Zheng Songshan;Chai Chang(People's Hospital of Henan University,Henan Provincial People's Hospital,Henan Eye Hospital,Zhengzhou 450003,China)

机构地区：[1]河南大学人民医院、河南省人民医院眼科、河南省立眼科医院,郑州450003

出　　处：《中华实验眼科杂志》2023年第11期1105-1110,共6页Chinese Journal Of Experimental Ophthalmology

摘　　要：目的分析眶底爆裂性骨折修复术后持续性复视的影响因素。方法采用病例对照研究,收集2011年7月至2020年7月在河南省立眼科医院诊治的术后1 d即存在复视的眶底爆裂性骨折患者146例146眼的病历资料,根据观察期间内复视是否持续存在分为持续复视组14例14眼和复视消失组132例132眼,比较2个组不同性别、眼别、年龄、术前病程、术前眶内软组织嵌顿程度、手术方法、手术入路、术后眼球转动锻炼依从性、术后下直肌损伤程度眼数的差异,筛选P<0.05的因素进行多因素Logistic回归分析。结果所有患眼均成功地进行了手术,术后随访期间所有患眼均未出现眼眶植入物感染、移位等并发症。2个组间不同年龄分类、术前病程、术前眶内软组织嵌顿程度、手术方法、术后眼球转动锻炼依从性、术后眼外肌损伤程度眼数比较,差异均有统计学意义(χ^(2)=9.443,P=0.002;χ^(2)=29.041,P<0.001;H=53.943,P<0.001;H=34.583,P<0.001;χ^(2)=46.041,P<0.001;H=101.438,P<0.001)。多因素Logistic回归分析结果显示,术前长病程(OR=8.678,95%CI=1.013~74.304,P=0.031)、术前眶内软组织嵌顿(重度:OR=32.963,95%CI=7.647~142.084,P<0.001.中度:OR=11.852,95%CI=2.679~52.436,P=0.001)、术后下直肌损伤(重度:OR=511.000,95%CI=42.815~6110.808,P<0.001.中度:OR=132.000,95%CI=12.442~1400.458,P<0.001)是术后持续性复视的独立危险因素。先进的手术方法(个体化塑形钛网法:OR=0.020,95%CI=0.002~0.127,P<0.001.厂家预制钛网法:OR=0.031,95%CI=0.004~0.257,P=0.001)、术后眼球转动锻炼依从性良好(OR=0.015,95%CI=0.001~0.197,P<0.001)是术后持续性复视的独立保护性因素。结论眶底爆裂性骨折修复术前严重眶内软组织嵌顿和术后下直肌的不可逆损伤是术后持续性复视的主要危险因素,缩短术前病程、改善手术方法、增强术后眼球功能锻炼可降低术后持续性复视的发生率。Objective To investigate influencing factors of persistent diplopia after orbital floor blowout fracture reconstruction surgery.Methods A case control study was conducted.Data of 146 eyes of 146 orbital floor blowout fracture patients with diplopia occurring 1 day after operation were collected in Henan Eye Hospital from July 2011 to July 2020.The patients were divided into two groups,persistent diplopia group(14 cases 14 eyes)and disappeared diplopia group(132 cases 132 eyes),according to the persistence of diplopia in the follow-up.Differences in sex,right or left eye,age,preoperative course of disease,preoperative intraorbital soft tissue hernia,operation methods,operation approach,postoperative eyeball rotation exercise compliance,the number of eyes with postoperative inferior rectus muscle damage level were compared between the two groups to select factors with P<0.05 for multifactor logistic regression analysis.This study protocol adhered to the Declaration of Helsinki and was approved by the Ethics Committee of Henan Eye Hospital(No.HNEECKY-2021[15]).Results All eyes were successfully operated and no complications such as infection or dislocation of the orbital implant occurred in any of the eyes during the postoperative follow-up period.There were statistically significant differences in age,preoperative course of disease,preoperative intraorbital soft tissue hernia,operation methods,postoperative eyeball rotation exercise compliance and postoperative inferior rectus muscle injury between the two groups(χ^(2)=9.443,P=0.002;χ^(2)=29.041,P<0.001;H=53.943,P<0.001;H=34.583,P<0.001;χ^(2)=46.041,P<0.001;H=101.438,P<0.001).The multiple logistic regression analysis indicated that the long preoperative course of disease(OR=8.678,95%CI=1.013-74.304,P=0.031),preoperative intraorbital soft tissue hernia(Severe:OR=32.963,95%CI=7.647-142.084,P<0.001.Moderate:OR=11.852,95%CI=2.679-52.436,P=0.001),and postoperative inferior rectus muscle injury(Severe:OR=511.000,95%CI=42.815-6110.808,P<0.001.Moderate:OR=132.000,95%CI=

关 键 词：眼眶骨折 眼眶手术 并发症 复视 眶底 

分 类 号：R779.6[医药卫生—眼科]