안와 내벽의 단독 외향 골절에서의 골절 정복의 수술적 결과
Outcomes of Isolated Medial Orbital Wall Fracture Reconstructions
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목적: 안와 내벽의 단독 외향 골절에서의 골절 정복술을 받은 환자를 대상으로 수술 결과를 보고하고자 하였으며 골절의 재건 정도에따른 안구 함몰 정도를 확인하고자 한다. 대상과 방법: 2012년 3월부터 2013년 10월까지 안와 내벽 골절로 누구 접근법을 이용해 정복술을 시행 받은 환자를 대상으로 후향적으로 분석하였다. 모든 환자에서 술 전후 전산화 단층촬영을 시행하였으며 수술 후 1주, 1달, 3개월에 내원하여 안구돌출계측검사를시행하고 안구운동장애, 복시, 술 후 합병증 여부를 확인하였다. 안구함몰 정도는 전산화 단층촬영에서의 안구 면적/안와 면적의 비율을 구해 안구돌출계측 값과 비교했으며 삽입물의 위치와 탈출된 조직 여부를 기준으로 정복 정도를 완전정복과 불완전정복으로 나누어 수술 결과를 비교하였다. 결과: 총 55명이 대상이었으며 남자 42명, 여자 13명이었고 평균연령 36세였다. 수술 전 5명의 환자에서 2 mm 이상의 안구함몰을보였으며 수술 후 모두 잘 교정되었다. 수술 전 9명의 환자에서 정면 주시 시 복시가 있었으며 수술 후 모두 증상이 호전되었으나2명의 환자에서 가쪽 주시 시 복시가 남았다. 완전정복군과 불완전정복군 모두에서 수술 전후로 안구 돌출계측 값과 안구 면적/안와면적의 비율의 차이는 보이지 않았다. 결론: 본 연구에서 55명 환자의 안와 내벽의 단독 외향 골절의 정복은 성공적으로 이루어졌고 안구함몰 및 복시가 호전되는 긍정적결과를 보였다. 안와 골절에서 후방부분의 완전정복이 이루어지지 않더라도 전방부분의 정복이 잘 이루어진다면 임상적으로 유의한안구함몰은 발생하지 않을 것이라 생각한다.
Abstract
Purpose: To evaluate surgical results after the reconstruction of isolated medial orbital wall fractures. Methods: We performed a retrospective chart review of patients with isolated medial orbital wall fractures who underwent reconstructionusing the transcaruncular approach from March 2012 to October 2013. Computed tomography (CT) was performedbefore and after surgery. Postoperative follow-ups were conducted at 1 week, 1 month, and 3 months. Diplopia, ocular motility,postoperative complication, and exophthalmometry were recorded at each follow-up visit. Preoperative and postoperativeenophthalmos was quantified using Hertel exophthalmometry and a quantitative method for the area of the circular sector underthe chord (CA)/orbital area (OA) ratio at the CT scan. Patients were divided into either the incomplete or complete reductiongroups based on the degree of reduction observed on postoperative CT. Results: We evaluated 55 patients (42 males, 13 females) with an average age of 36 years. Five of 55 patients with preoperativeenophthalmos of more than 2 mm obtained good symmetry after surgery. Diplopia at primary gaze was resolved in 9 of 9 patientsand 2 patients had residual diplopia on lateral gaze. The difference of exophthalmometry and CA-to OA ratio between before andafter reconstruction was not significantly changed in either the incomplete or complete groups. Conclusions: Enophthalmos and diplopia were well corrected in all subjects. If reduction was successfully performed in the anteriorportion of medial orbital wall fracture, clinically significant enophthalmos might be preventable even if complete reductionwas not obtained.
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