目的:本研究旨在探讨初次眼眶骨折修复不充分后出现并发症的患者的临床特征,并评估二次眼眶翻修重建的手术效果。
方法:作者回顾性回顾了41例患者的数据,这些患者由一名外科医生在其他地方进行原发性眼眶骨折修复后出现并发症后接受了眼眶翻修重建。临床特征,包括眼球内陷,眼球突出,复视,眼运动受限,顿唇,眶下感觉减退,感染,眼睑错位,眼球,俯卧撑,和压迫性视神经病变,被评估。评估翻修手术的手术结果,以确定临床缺陷和术后患者满意度的改善。
结果:原发性眼眶骨折修复术后最常见的并发症是眼球内陷(n=20/41)和复视(n=20/41)。初次手术和翻修手术之间的平均时间为67.2个月(范围:1-276个月)。翻修手术显著改善眼球内陷,复视(赫斯面积比),顿体(蒙克得分),眶周疼痛,与修订前状态相比(分别为P=0.003,P=0.001,P<0.001,P<0.001和P=0.007)。此外,6例患者出现改善的眶下感觉减退。在41名患者中,23人很满意17满意1在修正眼眶重建后为中性。
结论:我们的研究强调了修复眼眶重建在解决原发性眼眶骨折修复不足引起的并发症方面的积极影响。外科医生应考虑进行翻修手术,以解决先前手术后的临床缺陷。尤其是在影像学研究中解剖异常明显时,无论从初次手术以来的时间流逝或对组织纤维化和脂肪萎缩的担忧。
OBJECTIVE: This study aimed to investigate the clinical characteristics of patients with complications following inadequate primary orbital fracture repair and to evaluate surgical outcomes of secondary revision orbital reconstruction.
METHODS: The authors retrospectively reviewed data from 41 patients who underwent revision orbital reconstruction by a single surgeon following complications from primary orbital fracture repair performed elsewhere. Clinical characteristics, including
enophthalmos, exophthalmos, diplopia, ocular motility limitation, epiphora, infraorbital hypoesthesia, infection, eyelid malposition, lagophthalmos, hypoglobus, and compressive optic neuropathy, were assessed. Surgical outcomes of revision surgery were evaluated to determine improvements in clinical deficits and postoperative patient satisfaction.
RESULTS: The most common postoperative complications of primary orbital fracture repair were
enophthalmos (n=20/41) and diplopia (n=20/41). The mean time between primary and revision surgeries was 67.2 months (range: 1-276 mo). Revision surgery significantly improved
enophthalmos, diplopia (Hess area ratio), epiphora (Munk score), periorbital pain, and exophthalmos ( P =0.003, P =0.001, P <0.001, P <0.001, and P =0.007, respectively) compared to the pre-revision state. In addition, 6 patients experienced improved infraorbital hypoesthesia. Among the 41 patients, 23 were very satisfied, 17 were satisfied, and 1 was neutral after revision orbital reconstruction.
CONCLUSIONS: Our study highlights the positive impact of revision orbital reconstruction in addressing complications from inadequate primary orbital fracture repair. Surgeons should consider revision surgery to address clinical deficits following prior surgery, especially when anatomic abnormalities are evident in imaging studies, regardless of the time lapse since the initial surgery or concerns about tissue fibrosis and fat atrophy.