단독 안와하벽골절 환자의 안와 전산화단층촬영 소견에 따른 복시 양상 및 수술 후 복시 경과
Diplopia after Isolated Inferior Orbital Wall Fracture According to the Computed Tomography Findings
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목적: 단독 안와하벽골절 환자에서 발생한 복시를 안와 전산화단층촬영 소견에 따라 분류하고 수술 후 경과 및 복시 양상에 영향을 미치는 요인들을 알아본다. 대상과 방법: 2001년 3월부터 2020년 12월까지 단독 안와하벽골절 발생 후 본원에서 수술적 치료를 받은 200명의 의무기록을 후향적으로 조사하였다. 복시는 문진 및 동적 자동시야계를 이용하여 주변부, 중심부, 전방향으로 분석하였고, 수술 전과 수술 후 1일, 1주, 6주, 6개월 경과 관찰 시 복시의 임상경과를 조사하였다. 수술 전 CT 영상에서는 골절 크기(소, 중, 대), 위치(앞, 중간, 뒤), 외안근 두께(부종, 변형), 외안근 위치(끼임, 탈출), 외안근 형태(당김 유무)로 나누어 분석하였다. 결과: 수술 전 복시는 전체 200명 중 144명(72.0%)으로, 주변부 복시 57명(39.6%), 중심부 복시 46명(24.3%), 전방향 복시 20명(13.9%) 순이었다. 수술 전 복시는 수술 전 안구운동제한 여부(p<0.001)와 외안근의 위치(p=0.022)에 따라, 수술 전 복시 양상은 안구운동제한의 방향에 따라 차이가 있었다(p=0.018). 또한 외안근의 두께가 복시 양상에 영향을 주는 것으로 나타났다(p=0.020). 수술 6개월 후 복시가 지속된 환자는 33명(16.5%)으로, 주변부 복시 회복 속도가 가장 빨랐다. 결론: 단독 안와하벽골절 환자에서 수술 전 안구운동제한 양상과 안와 전산화단층촬영 소견에 따라서 복시의 경과를 예측하는 데 참고할 수 있다.
Abstract
Purpose: To investigate the postoperative changes in diplopia and evaluate factors that affect diplopia after isolated inferior orbital wall fracture. Methods: A retrospective study was conducted on 200 patients who underwent reconstruction surgery for isolated inferior orbital wall fracture between March 2001 and December 2020. Diplopia was categorized into peripheral, central, and full-degree types based on the history and binocular single vision. The natural course of diplopia was analyzed pre-operatively and at 1 day, 6 weeks, and 6 months postoperatively. We analyzed the orbital computed tomography images to determine fracture size (small, medium, or large), fracture site (anterior, middle, posterior, or mixed), extraocular muscle (EOM) size (swelling or deformity), EOM site (incarcerated or prolapsed), and EOM tenting. Results: Diplopia was seen in 144 out of 200 patients (72.0%) before surgery; peripheral diplopia was seen in 57 patients (39.6%), central diplopia in 46 (24.3%), and full-degree diplopia in 20 (13.9%). Pre-operative diplopia differed according to the pre-operative limitation of range of motion (LOM) (p < 0.001) and EOM site (p = 0.022). Pre-operative diplopia type differed according to the LOM direction (p = 0.018) and EOM size (p = 0.020). Diplopia persisted in 33 patients (16.5%) 6 months after the surgery. Recovery was faster in patients with peripheral diplopia compared to those with central or full-degree diplopia. Conclusions: The presence of diplopia was associated with the pre-operative LOM and EOM site but the type of diplopia was associated with LOM direction and EOM size. These factors can be used to predict the progression of diplopia in patients with isolated inferior orbital wall fracture.
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