안와하내벽 골절에서 내시경 코경유 및 결막접근법 조합과 눈물언덕 및 결막접근법 조합의 비교
Endoscopic and Transconjunctival versus Transcaruncular and Transconjunctival Reconstruction of Medial and Inferior Orbital Wall Fractures
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목적: 안와하내벽 동반골절 환자에서 내시경을 이용한 코경유 접근법과 결막 접근법을 동시에 사용한 경우와 눈물언덕과 결막을 통한 접근법의 차이에 대하여 비교하였다. 대상과 방법: 2011년부터 2014년까지 인하대학교병원 안과에서 안와내벽, 하벽 동반골절을 진단받고 내시경을 이용한 코경유 접근골절 복원술과 결막접근 골절 복원술을 동시에 시행한 29명과 눈물언덕 접근 골절 복원술과 결막접근 골절 복원술을 동시에 시행한 34명의 수술 전, 수술 6개월 후의 안구운동검사, 복시검사, 안구돌출계 검사를 시행하였다. 결과: 내시경을 이용한 코경유 접근법과 결막접근법으로 안와 골절 복원술을 시행한 환자군과 눈물언덕과 결막을 통한 접근법을 시행한 환자의 수술 전, 6개월 후의 정면주시 복시, 주변부 복시, 안구운동제한, 안구함몰이 남는 정도를 비교한 결과 내시경을 이용한 코경유 접근법과 결막접근법을 시행한 환자군에서 수술 6개월 후 안구돌출계 검사의 양안 차이가 남는 비율이 더 적은 것으로 측정되었다. 결론: 본 연구에서는 내시경을 이용한 코경유 접근과 결막접근법을 같이 시행한 수술법이 눈물언덕 접근, 결막접근법을 같이 시행한 경우보다 일부 측정값에서 더 좋은 결과를 나타내어 안와 내벽과 하벽골절이 동시에 있을 경우 또 다른 좋은 수술 접근 방법이 될 수 있을 것으로 생각된다.
Abstract
Purpose: To compare two combined surgical techniques, endoscopic endonasal surgery with transconjunctival reconstruction and transcaruncular surgery with transconjunctival reconstruction, when used to treat both medial and inferior orbital wall fractures. Methods: A retrospective review of 63 patients who were followed up from January 2011 to December 2014 at Inha University Hospital for surgical reconstruction of combined medial and inferior orbital wall fractures was undertaken. We compared between the patients the computed tomographic scans, diplopia, extraocular muscle (EOM) movements, and Hertel's exophthalmometer exams pre- and post-6 months surgery. A total of 29 patients received endoscopic transnasal surgery with trasconjunctival reconstruction, and 34 received transcaruncular surgery with trans-conjunctival reconstruction. Results: There were no significant differences between the two combined methods in terms of the primary and peripheral gaze diplopia or the restriction of EOM movement 6 months after surgery. However, statistically significant differences were observed in exophthalmometer measurements 6 months after surgery. Conclusions: The two combined surgical methods showed similar results in terms of postoperative primary and peripheral gaze diplopia, EOM restriction, and enophthalmos. With respect to postoperative peripheral diplopia, endoscopic endosnasal surgery with transconjunctival reconstruction showed several advantages over the other method considered in this study. An appropriate surgical method should be selected by comparing the relative advantages and disadvantages.
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