단독 안와내벽 골절에서 내시경을 이용한 코 경유 접근과 눈물언덕접근을 통한 복원술의 비교
Endoscopic Transnasal versus Transcaruncular Reconstruction in Isolated Medial Orbital Wall Fractures
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목적: 단독 안와내벽 골절 환자에서 내시경을 이용한 코 경유 접근을 통한 안와골절 복원술과 눈물언덕 접근을 통한 안와골절 복원술을 비교하였다. 대상과 방법: 2011년 1월부터 2012년 12월까지 인하대병원 안과에서 단독 안와내벽 골절을 진단 받고 내시경을 이용한 코 경유 접근골절 복원술을 시행한 35명과 눈물언덕 접근 골절 복원술을 시행한 44명의 환자를 대상으로 수술 전후 전산화단층촬영, 안구운동검사, 복시검사, 안구돌출계 검사를 시행하였다. 결과: 내시경을 이용한 코 경유 접근법으로 안와골절 복원술을 시행한 환자군과 눈물언덕 접근법으로 안와골절 복원술을 시행한 환자군의 수술 6개월 후 정면주시 복시(p=0.50), 안구운동제한(p=0.48), 2 mm 이상 안구함몰이 남는 정도(p=0.99), 안구함몰의 변화량(p=0.07)을 비교하였을 때 통계적으로 유의한 차이가 없었다. 내시경적 코 경유 접근법을 시행한 환자군에서 수술 6개월 후 주변부복시가 더 적었다(p=0.04). 결론: 안와내벽 골절 환자의 내시경을 이용한 코 경유 접근과 눈물언덕 접근을 통한 복원술이 수술 후 정면 복시, 안구운동제한, 안구함몰이 남는 정도, 안구함몰의 변화량에서 비슷한 치료 결과를 나타내었으며, 내시경을 이용한 코 경유 접근법으로 안와골절 복원술을 시행한 환자들의 6개월 뒤 주변부 복시가 적었다. 각각의 장단점을 비교하여 수술법을 선택해야 하겠다.
Abstract
Purpose: To compare 2 surgical techniques, endoscopic transnasal reconstruction and transcaruncular reconstruction in isolated medial orbital wall fractures. Methods: This study included 79 isolated medial orbital wall fracture patients from January 2011 to December 2012 of Department of Ophthalmology, Inha University Hospital. The authors compared computed tomographic scans, diplopia, extraocular muscle (EOM) movements, and Hertel's exophthalmometer exams pre- and post-surgery. Thirty-five patients received endoscopic transnasal reconstruction and 44 received transcaruncular reconstruction. Results: The 2 surgical methods showed no significant differences in primary gaze diplopia (p = 0.50), restriction of EOM movements (p = 0.48), remaining enophthalmos of more than 2 mm (p = 0.99), and improvement in enophthalmos (p = 0.07) when compared 6 months after surgery. Statistically significant differences were observed in peripheral diplopia (p = 0.04) 6 months after surgery. Conclusions: The 2 surgical methods present similar effectiveness in postoperative primary gaze diplopia, EOM restriction, and enophthalmos. With respect to postoperative peripheral diplopia, endoscopic transnasal reconstruction method showed advantages. The surgical method should be selected by comparing advantages and disadvantages.
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