안와골절 정복술: 조기수술과 지연수술의 결과
Orbital Wall Fracture Repair: The Results of Early and Delayed Surgery
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목적: 안와골절에 대한 조기수술과 지연수술의 결과를 수술시기를 세분화하여 알아보고자 하였다. 대상과 방법: 2002년 1월부터 2014년 12월까지 본원에서 안와 골절 정복술을 시행 받고 3개월 이상 추적관찰된 88명 88안을 대상으로 하였다. 수상 후 2주 이내에 수술을 받은 눈을 조기수술군, 수상 후 3주에서 2달 사이에 수술 받은 눈을 약지연수술군, 수상 2개월 이후에 수술 받은 눈을 지연수술군으로 분류하였다. 임상 기록 검토를 통해 임상 양상과 수술 전후의 복시와 안구 함몰의 호전 정도를 후향적으로 비교 분석하였다. 결과: 조기수술군은 30안, 약지연수술군은 42안, 지연수술군은 16안이었다. 수상 시기부터 수술까지의 평균 기간은 조기수술군 1.5 ± 0.5주, 약지연수술군 3.5 ± 1.2주, 지연수술군 35.3 ± 44.7주, 전체 모든 환자의 평균 기간은 8.6 ± 22.5주였으며 전체 환자의 평균 추적관찰 기간은 12.9 ± 10.8주였다. 세 군 모두에서 상방 주시의 안구 운동 장애가 가장 많았으며 수술 후 모든 군에서 전방향의 안구 운동 장애가 호전되었다. 수술 전후의 호전 정도와 호전 상태는 세 군 간 유의한 차이를 보이지 않았다. 안구 함몰 또한 세 군에서 모두 호전되었으며 세 군 간 호전 정도의 유의한 차이는 없었다. 결론: 안와골절 환자에서 안와골절정복술 후 안구운동 장애와 안구함몰 호전 정도의 수술시기에 따른 차이는 없었으며, 따라서 수상 후 오랜 시간이 지난 안와골절에서 안와골절 정복술은 증상 호전에 도움이 될 수 있다.
Abstract
Purpose: To investigate the surgical results of early and delayed repair of orbital wall fracture after multiple subgrouping of patients by time between the operation and injury. Methods: Eighty-eight eyes of 88 patients who underwent orbital wall fracture repair from January 2002 to December 2014 and who were followed up for more than 3 months postoperatively were included in this study. We divided the 88 patients into three groups: Early surgery group (surgery within 2 weeks after the injury), slightly delayed surgery group (surgery between 3 weeks and 2 months after the injury), delayed surgery group (surgery after 2 months of the injury). Preoperative and postoperative ocular motility, diplopia, and the degree of enophthalmos were analyzed retrospectively. Results: The early surgery group consisted of 30 eyes; slightly delayed surgery group, 42 eyes; and delayed surgery group, 16 eyes. The mean duration between injury and surgery was 8.6 ± 22.5 weeks in all patients, 1.5 ± 0.5 weeks in the early surgery group, 3.5 ± 1.3 weeks in the slightly delayed surgery group, and 35.3 ± 44.7 weeks in the delayed surgery group. All patients were followed up for a mean of 12.9 ± 10.8 weeks. Gaze limitation in all directions showed improvement in all groups, with the most shown in up gaze limitation. There were no significant differences in the degree of improvement between preoperative and postoperative gaze limitation among the three groups. Enophthalmos improved as well, without any significant differences among the three groups. Conclusions: Improvement in ocular motility limitation and enophthalmos after orbital wall fracture repair did not vary significantly according to the duration between the surgery and injury. Therefore, surgical repairment even for old orbital fractures may successfully treat enophthalmos or diplopia and relieve symptoms.
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