노출된 하이드록시아파타이트 안와삽입물 재수술의 위험요인
Risk Factors Associated with Reoperation for Exposed Hydroxyapatite Orbital Implants
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목적: 노출된 하이드록시아파타이트 안와삽입물의 재수술을 높이는 위험요인을 알아보고자 한다. 대상과 방법: 2008년부터 2022년까지 단일기관에서 하이드록시아파타이트 안와삽입물의 노출을 진단받은 환자 중, 12개월 이상 경과관찰이 가능했던 34명(34안)의 환자를 대상으로 후향적 의무기록 분석을 하였다. 안와삽입물의 노출을 진단받은 환자는 우선 보존적치료를 시행하였으며, 보존적치료에도 통증, 분비물 등의 증상이 생기거나 노출 부위의 크기가 커지는 경우 수술적 치료를 시행하였다. 환자의 연령, 성별, 당뇨 유무, 술 전 진단, 수술법, 안와삽입물의 종류 및 크기와 노출 부위 크기를 조사하였고 회귀분석을 통해 재수술에 영향을 미치는 요인들을 분석하였다. 결과: 총 34명 중 17명에서 특별한 증상 없이 보존적치료로 삽입물의 노출이 치료된 반면 17명에서는 수술적 치료가 필요하였다. 회귀 분석 결과, 안와삽입물의 노출 부위 크기가 재수술에 통계적으로 유의한 영향을 주는 것으로 나타났다(p=0.018). 이외에 다른 요인들은 재수술에 유의한 영향을 미치지 않았다. 노출 부위 크기의 임계값을 알아보기 위해 ROC 분석을 하였고 4.5 mm에서 AUC 0.934, 민감도 0.882, 특이도 0.824를 보였다. 4.5 mm를 기준으로 Small 그룹과 Large 그룹으로 나누었을 때, 두 군 사이에 재수술률은 유의미한 차이가 있었다(p<0.001). 결론: 안와삽입물이 노출되었을 때 노출 부위 크기가 재수술을 결정하는 가장 중요한 요인으로 나타났다. 또한 노출 부위의 크기가 4.5 mm 이상인 경우 재수술 가능성이 높았다.
Abstract
Purpose: We evaluated risk factors associated with reoperation following exposed hydroxyapatite orbital implant placement. Methods: We retrospectively analyzed 34 patients (34 eyes) diagnosed with exposed hydroxyapatite orbital implants at our institution between 2008 and 2022; all patients had a minimum follow-up of 12 months. All patients initially received conservative management. However, if symptoms, such as pain, discharge, or progressive exposure persisted, surgery was undertaken. We analyzed several variables, including age, sex, diabetic status, preoperative diagnosis, surgical approach, implant type and size, and exposed implant surface area. Regression analysis was performed to identify variables associated with reoperation. Results: Of the 34 patients (34 eyes), 17 (50.0%) were managed conservatively, whereas 17 (50.0%) required surgical intervention. Regression analysis revealed a significant association between the size of the exposed area and the need for reoperation (p = 0.018); however, other factors did not significantly impact reoperation rates. Receiver operating characteristic curve analysis identified a threshold of 4.5 mm for exposed area size, with an area under the curve of 0.934, sensitivity of 0.882, and specificity of 0.824. Patients categorized into small and large groups based on the 4.5 mm threshold revealed a statistically significant difference in reoperation rates (p < 0.001). Conclusions: Our study demonstrates that the size of the exposed area is the single most significant predictor of revision surgery in patients with exposed hydroxyapatite orbital implants. Notably, an exposed area > 4.5 mm was associated with a significantly increased risk of reoperation.
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