단독 안와하벽골절복원술 후 회복되지 않는 고착화된 복시와 관련된 인자
Factors Affecting Persistent Diplopia after Surgical Repair of Isolated Inferior Orbital Wall Fracture
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목적: 단독 안와하벽골절복원술 시행 후 고착화된 복시와 관련된 인자를 알아보고자 하였다. 대상과 방법: 2014년부터 2017년까지 인하대학교병원 안과에서 단독 안와하벽골절을 진단받고 결막접근 안와골절복원술을 시행한 33명의 환자를 대상으로 수술 전후 얼굴 전산화단층촬영, 안구운동검사, 복시검사, 안구돌출계 검사를 시행하였다. 수술 후 6개월 이상 경과 관찰 후에도 회복되지 않는 복시를 고착화된 복시로 정의하였다. 단변수 로지스틱 회귀분석을 시행하여 수술 후 고착화된복시와 관련성이 있는 것으로 확인된 변수들을 평가한 후 다변수 로지스틱 회귀분석 시행하였다. 결과: 단변수 회귀분석에서 수술 전 안구운동제한, 수술 전 복시, 골절 유형, 골절부위와 외안근의 접촉 횟수, 외안근텐팅이 수술 후 고착화된 복시와 연관된 것으로 확인되었다. 다섯 가지 변수를 반영한 다변수 회귀분석에서 술 전 복시가 28.3배, 외안근텐팅이 17.4배 높은 고착화된 복시의 위험성이 있는 것으로 확인되었다(p=0.023). 결론: 본 연구에서는 수술 전 복시와 얼굴 전산화단층촬영 영상을 통해 분석한 외안근텐딩이 수술 후 고착화된 복시와 연관성이 높은 것으로 확인되었다. 향후 고착화된 복시의 예측인자로 고려할 수 있을 것으로 판단된다.
Abstract
Purpose: To investigate factors affecting persistent diplopia after surgical repair of isolated inferior orbital wall fractures. Methods: Thirty-three patients who underwent surgical repair of isolated inferior orbital wall fractures in Inha University Hospital Ophthalmology Department from 2014 to 2017 were enrolled in this study. The authors examined facial computed tomography, diplopia, extraocular muscle movement, and Hertel’s exophthalmometer before and 6 months after surgery. The diplopia which was not recovered even at 6 months postoperatively was defined as persistent diplopia. Multivariable logistic regression analyses were performed on parameters that were found to be related to persistent diplopia using univariable logistic regression analyses. Results: Univariable regression analysis showed that preoperative ocular motility limitation, preoperative diplopia, the type of fracture, the number of contacts with the fracture site and extraocular muscle (EOM), and EOM tenting were associated with persistent postoperative diplopia. Multivariable regression analysis using the previously mentioned five parameters showed 28.3- fold and 17.4-fold greater probabilities of diplopia after surgery in preoperative diplopia and EOM tenting, respectively (p = 0.023). Conclusions: Preoperative diplopia and EOM tenting were associated with persistent postoperative diplopia. These parameters were predictors of persistent diplopia in eyes with isolated inferior orbital wall fractures.
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