내직근 감돈을 동반한 안와내벽의 들창문형 골절의 임상양상 및 전산화단층촬영 소견
Clinical Manifestations and Computed Tomography Findings of Trapdoor Type Medial Orbital Wall Blowout Fracture
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목적: 내직근이 감돈된 안와내벽의 들창문형 골절의 임상양상을 보고하고자 한다. 대상과 방법: 2009년 3월부터 2016년 10월까지 내직근의 감돈을 동반한 안와내벽의 들창문형 골절에 대해 수술적 치료를 시행받은환자들의 임상 기록 및 전산화단층촬영 소견을 후향적으로 분석하였다. 결과: 대상 환자는 남자 6명, 여자 2명, 평균 나이는 14.4세였다. 주 증상은 안구운동장애 및 안구운동 시 통증 8명(100%), 복시 7명(87.5%), 오심 및 구토 4명(50%) 순이었다. 전산화단층촬영상 안와 첨부에서 골절 위치까지 거리는 평균 22.0 mm로 내벽 중간 위치에발생하였다. 2명은 골절 틈을 통하여 내직근이 완전하게 사골동 내로 빠져있었고, 6명의 환자는 골절 틈에 명확하게 끼어있었다. 외상안 내직근 단면적은 47.7 mm²로 반대안(40.1 mm²)에 비해 부종이 동반되었다. 수상 후 평균 4.1일째 눈물언덕을 경유한 안와골절정복술이 시행되었다. 안구심반사 증상으로 나타나는 오심 및 구토를 보인 환자들은 모두 수술 직후 증상이 소실되었다. 술 전 안구운동장애 소견을 보인 8명 중 6명의 환자에서 수술 직후 내전장애 소견을 나타냈다. 안구운동장애는 수술 후 평균 11.7일, 복시는 평균 46.7일후에 소실되었다. 결론: 내직근 감돈을 동반한 안와내벽의 들창문형 골절은 안구운동장애, 안구운동 시 통증, 복시, 안구심반사 등과 특징적인 전산화단층촬영 소견을 보였다. 상기 소견에 대한 이해와 빠른 수술적 처치가 필요하다. 안구운동장애의 형태로 수상 후에는 외전장애와 내전장애, 안와골절정복술 후에는 내전장애가 나타나는 경우가 흔하다.
Abstract
Purpose: To report the clinical manifestations and computed tomography (CT) findings of patients with a trapdoor type medial orbital wall blowout fracture. Methods: From March 2009 to October 2016, the clinical records and computed tomography findings of patients who underwent surgical treatment for a trapdoor type medial orbital wall blowout fracture were retrospectively analyzed. Results: A total of eight patients (six males and two females) were enrolled with a combined mean age of 14.4 years. Clinical manifestations were eyeball movement limitation (abduction and adduction) and ocular motility pain (eight patients, 100%), diplopia (seven patients, 87.5%), and nausea and vomiting (four patients, 50%). On CT, the distance from the orbital apex to the fracture site was an average of 22.0 mm and occurred in the middle position of the entire wall. Two patients had missed rectus completely dislocated into the ethmoid sinus through the fracture gap and six patients had definite involvement in the fracture gap and edema of the medial rectus muscle. The medial rectus muscle cross-sectional area was 47.7 mm² which was edematous compared to the contralateral eye (40.1 mm²). Orbital wall reconstruction was performed an average of 4.1 days after the injury. In all patients with oculocardiac reflex-like nausea and vomiting immediately improved after surgery. Six out of eight patients who had eyeball movement limitations (abduction and adduction) preoperatively showed adduction limitation after surgery. The eyeball movement limitation and diplopia disappeared 11.7 days and 46.7 days after surgery, respectively. Conclusions: Patients with trapdoor type medial wall blowout fracture showed characteristic computed tomographic findings and clinical manifestations such as eyeball movement limitation, ocular motility pain, diplopia, and oculocardiac reflex. An understanding of clinical findings and quick surgical treatment are therefore required. The type of eyeball movement limitation was abduction and adduction limitation preoperatively and adduction limitation postoperatively.
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