안와골절 환자에서 수술 전후의 복시와 안구회선의 비교

김경래,박성표,김형균 대한안과학회 2015 대한안과학회지 Vol.56 No.2

목적: 안와골절 환자에서 시신경 유두 중심과 망막중심 오목의 위치관계를 이용하여 안구회선 정도를 측정하여 안와골절 정복술 전후의 안구회선 정도의 변화를 측정하고 수술 전후 복시와 연관성을 알아보고자 하였다. 대상과 방법: 안와골절로 진단받고 본원에서 안와골절 정복술을 받은 환자군 36명과 나이대를 맞춘 대조군을 36명을 설정하였다.모든 대상자는 안저사진을 이용하여 시신경 유두 중심을 지나는 가상의 수평선과 시신경유두중심과 망막중심오목을 지나는 가상의선이 이루는 각도를 측정하여 안구회선의 정도를 측정하였다. 안와골절 환자군에서 수술 후 복시가 호전된 군과, 수술 전 복시가 없거나 수술 후 복시가 호전되지 않는 군과의 안구회선 정도를 paired t-test를 이용하여 비교하였다. 결과: 안와골절 환자군에서 수술 전후 통계적으로 유의하게 감소하였다(p=0.001). 수술 후 복시가 호전된 군의 수술 전 안구회선 정도는 7.74 ± 3.48도였으며, 수술 후 안구회선 정도는 5.02 ± 3.11도로 통계적으로 유의하게 감소하였다(p<0.001). 수술 전 복시가 없거나 수술 후 지속된 군의 수술 전 안구회선 정도는 6.36 ± 2.80도였으며, 수술 후 안구회선 정도는 6.51 ± 3.24도로 통계적으로 유의한 차이를 보이지 않았다(p=0.638). 결론: 안와골절 정복술로 인한 복시의 호전여부는 안구회선 정도의 변화와 관련이 있는 것으로 생각한다. 안와골절 정복술로 인한안구회선 정도의 감소와 회선사시의 연관성에 관하여 추가적인 연구가 필요할 것으로 생각한다 Purpose: We compared ocular torsion rates in blow-out fracture patients before and after blowout fracture repair by analyzingmean disc foveal angles. Methods: The study participants were divided into 2 groups: blow-out fracutre repair patients (n = 36) and controls (n = 36). We measured ocular torsion rates by analyzing mean disc foveal angle. The angle was composed of 2 imaginary horizontal lines which crossed the optic disc center and fovea. We compared statistically ocular torsion rates in blow-out fracture patients based on subsided diplopia, continued diplopia, or absence of diplopia before and after blow-out fracture repair using paired t-test. Results: In the patient group, ocular torsion rates were statistically significantly decreased. In the blow-out fracture repair group with subsided diplopia, ocular torsion rates were decreased statistically from 7.74 ± 3.48 degrees before blow-out fracture repair to 5.02 ± 3.11 degrees after blow-out fracture repair. In the blow-out fracture repair group with continued diplopia or absence of diplopia before surgery, ocular torsion rates did not change statistically significantly from 6.36 ± 2.80 degrees before blow-out fracture repair to 6.51 ± 3.24 degrees after blow-out fracture repair. Conclusions: Subsided diplopia after blow-out fracture repair and ocular torsion rate changes were significantly related in blow-out fracture patients. Further research which on the correlation of intraorbital change and movement of orbital position after blow-out fracture repair with ocular torsion rates are necessary.

소아 안와 골절의 임상 분석

박창식,김용규,정성모 대한성형외과학회 2008 Archives of Plastic Surgery Vol.35 No.5

Purpose: Because of traffic accidents and many criminal violences, the incidence of facial trauma has been increasing not only in adults but also in children. We planed this study to introduce our experience about pediatric blow out fracture and provide more information. Methods: We made retrospective study in 76 children with blow out fracture from January 2001 to September 2005 by retrospective chart review including detailed preoperative and postoperative evaluations, age, sex, cause, symptom and sign, and their post-operative complications. Results: Among our patients, 69 were male and 7 were female. The ages ranged from 7 to 18 years, which shows the greatest incidence of blow out fracture. Physical violence(46%) was the most common cause in this group and was followed by vehicle accident(28%), and fall down accident(17%). Left side(64%) showed slightly more incidence than right side(36%), but there were no statistical importance. Ecchymosis(88%) was the most common symptom and followed by periorbital swelling(68%) and diplopia(30%). 30 patients was diagnosed with another facial bone fracture and nasal bone(51%) was the most common associated facial bone fracture. Fourty four Patients(60%) got an orbital wall reconstruction in 7 days after trauma. After the operation, only 3 patients(4%) suffered from diplopia postoperative 3 month, and resolved in 4 years. Conclusion: The incidence of blow out fracture in children has been increasing every year, and violence has become more important etiology of pediatric blow out fracture and public and private education institutions were the most common place that blow out fracture originated. Accurate diagnosis and careful treatment plans are important in pediatric blow out fracture.

안와파열골절 급성기의 CT영상을 이용한 계측학적인 연구

정성호,신승한,박승하,구상환 대한성형외과학회 2007 Archives of Plastic Surgery Vol.34 No.1

Purpose: Blow-out fracture is one of the most common fractures in facial trauma. It is diagnosed by Computed Tomography(CT) scan, which is considered as the most effective diagnostic tool. Since, the Picture Archiving Communication System(PACS) has been provided recently to many hospitals, doctors are more familiar with imaging software of PACS. Because this software has many useful measuring tools, doctors can measure orbital structure easily and make a plan for treatment with its data. Therefore, authors intended to analyze the data of orbital structure measured with PACS imaging software and evaluate its usefulness. Methods: The charts and CT images of 100 patients, which were 50 patients with medial wall fracture and 50 patients with floor fracture, were reviewed. Patients were selected by pre-determined criteria and their CT images were measured with image software of PACS. 'Extraocular muscle thickness', 'Defect ratio'(ratio of defect area to normal area) and 'Globe position index' were measured and analyzed statistically.Results: The thickness of inferior rectus muscle and medial rectus muscle was simultaneously increased in acute-stage of blow-out fracture. The medial rectus muscle was more thickened in medial wall fracture and inferior rectus was more thickened in floor fracture, respectively. In acute blow-out fracture, globe position is exophthalmic rather than enophthalmic. Especially in floor fracture, numerical value summed up thickness of all extraocular muscle is correlated to the defect ratio and globe position index. Conclusion: Clinicians can decide globe position or presume defect ratio in inferior wall fracture by measurement of CT image in acute blow-out fracture using PACS.

안와 파열골절 후 발생한 중증 안검하수의 치료

김남훈,양정열,문재원,김규보,천지선,Kim, Nam-Hun,Yang, Jeong-Yeol,Moon, Jae-Won,Kim, Gyu-Bo,Cheon, Ji-Seon 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.4

Purpose: Blepharoptosis can result from either congenital or acquired causes. Blow out fracture or facial bone fracture including blow out fracture can be one of the causes. Authors experienced 3 cases of severe blepharoptosis after blow out fracture treated only with observation after reduction of associated fracture. Methods: Reconstruction of orbital wall was conducted on all cases diagnosed as blow out fracture using 3 dimensional computed tomography, and conservative treatment was done on accompanying severe blepharoptosis. Results: At the time of injury, all cases showed severe blepharoptosis requiring frontalis muscle transfer for correction. But blepharoptosis was recovered in an average of 18 weeks without any surgical procedure except reconstruction of orbital wall. Conclusion: Once Blepharoptosis occurred after blow out fracture, thorough evaluation must be done at first. If definitive cause of blepahroptisis cannot be found as authors' cases, injury of oculomotor nerve may result in blepharoptosis. So, as for blepharoptosis after blow out fracture, conservative treatment following reconstruction of fractured orbital wall can be one of good management.

眼窩粉碎骨折의 診斷과 治療 : 眼科的 合病症을 中心으로 Specifically Concerning the Ocular Complication

李熙哲,姜信益 인제대학교 1985 仁濟醫學 Vol.6 No.2

안와분쇄골절(Orbital Blow-out fracture)의 존재와 그 병태에 관한 최초의 언급은 1889年 Lang氏에 의해서 외상성 안구 함몰(Traumatic Enopthalmos)라고 불리면서였으며 1943年 King氏와 Samuel氏는 外力이 안구를 통하여 안와벽이 전달되어 골절이 유발된다는 작용기전을 설명하였고 1957年 Smith氏와 Regan氏는 그 기전이 外力의 직접 전달이 아니라 안압의 상승에 의한다는 것을 사체 실험으로 증명하였다. 그러나 blow-out fracture時 안구운동장애, 복시, 시력 감퇴, 안구 함몰의 치료에 관한 언급은 1957年 Converse氏와 Smith氏에 의하여 外科的 方法으로 Entrap된 연조직을 release시키고 안와 하벽을 재건하는 술식이 도입되었으며 Blow-out fracture라는 용어를 처음으로 사용하게 되었다. 그후, 진단 방법과 수술 방법이 개선되어 현재에 이르고 있으나 우리의 현실에 있어서는 그 개념의 혼동이 존재하고 있어 많은 환자들이 적절한 치료를 받지 못하고 있는 것이 사실이다. 이에 本人은 1981年 7월부터 1984年 6月 30日까지 本院에 내원한 Mid-facial fracture 89 Case를 주 대상으로 Blow-out fracture時 시신경 조직 손상에 의한 시력의 기능적 이상안모의 심미적 손상의 예방 및 치료에 관한 통일적인 접근법을 모색하고자 한다. Blowout fracture of the orbit was described at first in 1889 by Lang, and surgical correction of the blowout fracture was performed at first in 1957 by Converse. The concept in the diagnosis and treatment of the blowout fractures was reviewed by literatures and specifically the ocular complications in the periorbital bone fractures were studied. The main signs and symptoms of the blow- out fracture of the orbit are enophthalmos, vertical diplopia and ocular motility limitation and the corrective surgery is directed to the disengagement of the entraptted orbital fat and muscles, and reconstruction of the orbital floor with allogenic or autogenic graft materials. We used lyophilized dura(Lyodura) in the reconstruction of the fractured orbital floor, and obtained good results. The cases seen and treated in the Dept.of Oral and Maxillofacial Surgery, Inje Medical College Paik Hospital were reviewed. In 89 midfacial fractures, blow-out fractures were 14 cases (15.7%). Of the 89 midfacial fractures patients 19 patients had notable ocular complications and 7 patients lost their vision due to the global rupture and direct or indirect optic nerve injuries. In the midfacial fractures including the blowout fractures, there was relatively high incidence of ocular and neurological complications, so systematic approach through the team approach including oral surgeon, ophthalmologist and neurosurgeon should be emphasized, and then the patients would have better prognosis.

풍선 달린 카테터를 이용한 안저 파열 골절 정복의 선택적 사용

박성훈,양호직 대한성형외과학회 2007 Archives of Plastic Surgery Vol.34 No.6

Purpose: The operative treatment for blow-out fracture involves restoration of intra-orbital soft tissue and bony structural integrity. There are several methods for reconstruction of inferior blow out fracture. We report reduction of inferior blow-out fracture with urinary balloon catheter in comparison with Medpor using group to complication rate.Methods: A retrospective study was performed on 67 patients who underwent inferior orbital blow-out fracture reconstruction with Medpor implant or urinary balloon catheter following between 2003 and 2006. Hospital records were reviewed especially for preoperative and postoperative enophthalmos, diplopia, extraocular muscle movement limitations, and hypoesthesia between Medpor implant group and balloon catheter using group. Results: There was no significant statistical difference between both groups on incidence of postoperative complications of enophthalmos, diplopia, extraocular muscle movement limitations, and hypoesthesia. Postoperative infection, ectropion were absent in both groups.Conclusion: The use of urinary balloon catheter is simple, fast and inexpensive. Urinary balloon catheter is an alternative and reliable use for reduction of inferior orbital blow-out fracture.

Hydroxyapatite로 재건한 Orbital Blow-out fracture의 임상적 분석

황욱배,배용찬,황소민,황성호,김동헌,전재용 大韓成形外科學會 1998 Archives of Plastic Surgery Vol.25 No.6

The blow-out fracture can be reconstructed by various autogeneous and alloplastic material. Particulate, nonresorbable hydroxyapatite is currently one of the choice of implant material available for reconstruction of blow-out fracture. Hydroxyapatite is radiopaque ceramic, physically and chemically similar to enamel and cortical bone. It is a biomaterial derived from natural corals to use as a bone graft substitute. And we looked into the clinical usefulness of 2 type of hydroxyapatite with their advantages and disadvantages in reconstruction of blow-out fracture. 183 patients with blow-out fracture who underwent surgical reconstruction with two types of hydroxyapatite from March 1933 to July 1977 have been analyzed the results of surgical reconstructions, and have been followed up for more than a year. And the condition of formerly inserted hydroxyapatite was observed in the patients who needed 2nd surgical reconstruction due to the enophthalmos. The disadvantages of hydroxyapatite are fragility, size and contour limitations. In spite of these demerits, hydroxyapatite can be one of the prospective materials to reconstruct orbital floor. Through the clinical experiences for 5 years, we have not found any of complications of exposure, infection, and foreign body reaction. Low rates of diplopia, limitation of ocular movement, and enophtalmos was observed. Hydroxyapatite was well adherent to adjacent orbital bone in most patients who needed secondary reconstruction for enopthalmos. In conclusion, our study shows that the availability of hydroxyapattite in reconstruction of blow-out fracture is recommendable, with low complication rates. Hydroxyapatite important appears to be well tolerated, and provides useful alloplastic prosthesis with few problems in reconstruction of blow-out fracture.

고연령 안와파열 골절 환자의 수상 원인과 컴퓨터 단층촬영 소견 및 동반 골절의 연령별 비교

서동우 ( Dong Woo Seo ),손창환 ( Chang Hwan Sohn ),정상구 ( Sang Ku Jung ),안신 ( Shin Ahn ),김원영 ( Won Young Kim ),김원 ( Won Kim ) 대한외상학회 2009 大韓外傷學會誌 Vol.22 No.1

Purpose: The purpose of this study was to evaluate the causes of blow-out fractures, the computed tomography findings, and the associated facial bone fractures in aged patients. Methods: This study was performed by conducting a chart review. From January 2004 to December 2007, the patients who visited the emergency room of Asan Medical Center and were diagnosed as having a blow-out fracture were included in the study population. Patients 60 years of age or older were grouped as the aged group while patients younger than 60 years of age were grouped as the control group. Results: Between the aged group and the control group, there was a difference in the causes of blow-out fractures. The most common cause of blow-out fracture was a slip down in the aged group and violence in the control group (p<0.05). There were no differences in associated symptoms. Extraocular muscle herniation was the only statistically different computed tomography findings. In associated facial bone fractures, the most common fractures were the zygoma in the aged group and the nasal bone in the control group (p<0.05). Conclusion: In patients 60 years of age or older, the most common cause of blow-out fracture was a slip down, and the most common associated facial bone fracture was a zygomatic fracture. (J Korean Soc Traumatol 2009;22:44-50)

안와파열골절 재건의 임상적 고찰

임홍철,이명주 大韓成形外科學會 1996 Archives of Plastic Surgery Vol.23 No.5

A blow-out fracture is caused by the application of a traumatic force to the rim or the soft tissues of the orbit accompanied by a sudden increase in intraorbital pressure. The frequent site of blow-out fracture are the thin portions of the floor and medial wall of the orbit. Blow-out fracture may easily be overlooked because they give clinical symptoms in only a few instances, and in an area difficult to visualize radiologically. Thus the chance to diagnose this type of fracture depends solely on the throuness of the clinical examinations, the skill and persistence to find a blow-out fractures from February, 1993 to November, 1995. Among the them, we studied 36 patients who had follow-up study, based on the chart and X-ray. In conclusion, the authors state that (1) Unrecognized, untreated blow-out fractures result in significant functional and cosmetic defects. (2) Careful examination for signs of the blow-out fracture should be carried out. (3) Facial CT scan is superior to conventional radiograghy in diagnosis of blow-out fractures. (4) Adequate exposure is necessary for successful fracture reconstruction. (5) To correct the defect, we used bone and cartilage graft and alloplastic implants.

안와하내벽 파열골절의 임상적 의의

유재홍,하원,이지원,양완석,Yoo, Jae Hong,Ha, Won,Lee, Ji Won,Yang, Wan Suk 대한두개안면성형외과학회 2013 Archives of Craniofacial Surgery Vol.14 No.1

Background: The incidence of blow out fractures is increasing and the techniques of diagnosis and treatment have been recently evolving. Despite its clinical significance, there has been no study on orbital inferiomedial blow out fractures. Therefore, this study was designed to investigate the clinical significance of treatment of orbital inferiomedial blow out fractures. Methods: A retrospective review of fifty-seven patients who could be followed up for at least 1 year after surgical reconstruction of pure inferiomedial blow out fracture was undertaken. The transconjunctival approach was performed in all cases. The onlay technique was used in 32 patients and the inlay/sheet method was used in 25 patients. We evaluated the clinical outcomes using the chi-square test. Results: In the group using the onlay technique, postoperative diplopia and enophthalmos were observed in 14 cases and 3 cases, respectively. Of these, 5 cases and 3 cases lasted for more than 6 months, respectively. In the group using the inlay/sheet method, postoperative diplopia was observed in 9 cases, but there were no cases of enophthalmos. Among the 9 diplopia cases, 4 lasted for more than 6 months. Conclusion: Postoperative diplopia and enophthalmos were increased after treatment of inferiomedial blow out fractures compared to isolated medial (0.6%, 0.3%) or inferior (1.8%, 0.6%) blow out fractures. Therefore, careful dissection is necessary not to injure the inferior oblique muscle to decrease the incidence of postoperative diplopia. Moreover, the inlay/sheet method is an effective option for reconstruction of inferiomedial blow out fractures.