目的:比较不活动期Graves眼眶病变患者眼眶内侧壁减压术与平衡内外侧壁减压术在眼球突出减少方面的疗效及对生活质量的影响。
方法:将42例不活跃的Graves\'眼眶病患者随机分为两组,接受两种眼眶减压技术之一:眼眶内壁减压术或眼眶内侧加外侧壁减压术。术前和术后评估包括Hertel的眼球外测法和经过验证的Graves眼眶病生活质量问卷。比较两组的结果。
结果:与术前测量相比,两组的眼球突出减少均有统计学意义(p<0.001),但在接受眼眶内侧壁减压术的患者中更显著(p=0.010).两种眼眶减压技术均未增加Graves眼眶病生活质量问卷的视觉功能量表评分(眼眶下壁减压p=0.362,眼眶内侧壁减压p=0.727),但是在接受内侧和外侧壁眼眶减压术的患者中,外观量表的评分存在统计学上的显着差异(p=0.006)。
结论:眼眶内侧壁减压术对于不需要大的突眼复位的患者是一种很好的选择。然而,眼眶内侧加外侧壁减压术可提供更大的眼球突出减少和更大的外观改善(更高的Graves眼眶病生活质量问卷评分),使其成为审美功能康复的合适选择。
OBJECTIVE: To compare inferomedial wall orbital decompression to balanced medial plus lateral wall orbital decompression in patients with Graves\' orbitopathy in the inactive phase with regard to
exophthalmos reduction and the effects on quality of life.
METHODS: Forty-two patients with inactive Graves\' orbitopathy were randomly divided into two groups and submitted to one of two orbital decompression techniques: inferomedial wall orbital decompression or medial plus lateral wall orbital decompression. Preoperative and postoperative assessments included Hertel\'s exophthalmometry and a validated Graves\' orbitopathy quality of life questionnaire. The results of the two groups were compared.
RESULTS: Compared to preoperative measurement,
exophthalmos reduction was statistically significant in both groups (p<0.001) but more so in patients undergoing medial plus lateral wall orbital decompression (p=0.010). Neither orbital decompression techniques increased the visual functioning subscale score on the Graves\' orbitopathy quality of life questionnaire (inferomedial wall orbital decompression p=0.362 and medial plus lateral wall orbital decompression p=0.727), but a statistically significant difference was observed in the score of the appearance subscale in patients submitted to medial plus lateral wall orbital decompression (p=0.006).
CONCLUSIONS: Inferomedial wall orbital decompression is a good alternative for patients who do not require large
exophthalmos reduction. However, medial plus lateral wall orbital decompression offers greater
exophthalmos reduction and greater improvement in appearance (higher Graves\' orbitopathy quality of life questionnaire scores), making it a suitable option for esthetic-functional rehabilitation.