三维CT扫描测量眶爆裂性骨折的眶容积及其意义

目的　用三维CT扫描测量眼眶爆裂性骨折眶腔容积的变化情况 ,分析眼球内陷与眼眶容积改变的相关性 ,为开眶手术的设计、术后理想眼球突出度提供理论依据。方法　本实验使用美国螺旋CT机首先对 6具头颅骨标本 (12只眼眶 )进行直接测量并应用三维CT扫描技术进行影像测量的比较性研究 ,再选取了 10例眼眶爆裂性骨折病人 ,并以他们的正常眼作对照。用CT分别测量他们的眼眶体积。用Hertel突眼计测量眼球突出和眼球内陷的度数。并将以上各组数值分别进行统计学分析。结果　六具头颅骨标本的直接测量和三维CT扫描测量所得的眼眶体积结果一致 (P >0 0 5 ) ,两种测量方法无显著性差异 ;本实验测得眼眶爆裂性骨折病人眶腔体积显著高于对照组 (P <0 0 1) ,眼球内陷与容积的差值高度线性相关 ,相关系数R高达 0 982 (P <0 0 1)。眼球内陷 (y)与容积差值 (x)的相关规律的线性回归方程为 :y =0 171 0 776x。 结论　三维CT测量方法的结果准确稳定 ,具有较高的准确度和精确度 ,能替代直接测量。本研究结果提示了眼眶体积增加 1cm3 ,在Hertel突眼计上眼球将相应内陷约 0 8mm ,为外科手术提供了可参考的理论依据。     

眼眶肿瘤眼球突出952例

目的 探讨眼眶肿瘤致眼球突出的临床特征及相关因素。方法 总结门诊住院的眼眶肿瘤致眼球突出患者952例,分析临床表现及影像学检查。结果 952例眼球突出患者中发病较多依次为血管性肿瘤、神经源性肿瘤及泪腺肿瘤等。眼球突出度较正常眼突出2－7mm者最多。突出方向以轴性突出和前下方突出为主。结论 在眼眶肿瘤中血管性肿瘤、神经源性肿瘤及泪腺肿瘤是最常见致眼突的原因。眼突度多为2－7mm ,以轴突及前下方为多,眶内肿瘤和眼腔容积的改变均影响眼球位置。     

CT评估隧道式多孔聚乙烯植入材料修复眼眶骨折眶容积的改变

目的 探讨CT图像和计算机眼眶容积测算程序评估和预测隧道式多孔聚乙烯植入材料(MCI)修复大范围眼眶骨折后眼眶容积改变的临床意义.方法 收集单眼大范围眼眶骨折行MCI植入术且手术前、后检查资料完整患者16例,利用计算机Volume程序根据CT图像回顾性定量分析手术前、后眼眶容积的改变,使用Hertel突眼计测量手术前、后的眼球突出度.患者受伤到接受手术的平均时间为(17.4±10.0)d,平均随访时间为9个月.结果 手术后CT图像显示全部患者眼眶内前中段MCI位置良好.手术前伤眼眼眶容积[(28.16±4.32)cm3]与对侧健眼[(23.94±3.47)cm3]比较,差异有统计学意义(t=3.044,P＜0.01);手术后双眼眼眶容积比较,差异无统计学意义(t=0.069,P＞0.05).手术前、后眼眶容积的改变量与手术前眼球内陷程度相关(r=0.715,P＜0.01),缓解眼球内陷2 mm需手术整复眼眶容积2.86 cm3.结论 利用计算机客观测量眼眶容积可对创伤后眼眶骨折的严重程度和可能出现的眼球内陷进行预测.在大范围眼眶骨折导致眼眶容积改变时,在适应证范围内利用MCI行手术治疗是重建眼眶的有效方法,CT图像和计算机眼眶容积测算程序可为手术提供重要数据.     

眶部额骨内血管囊肿引起眼球突出1例

眼球后各种良恶性肿瘤引起眼球突出时有发生 ,但眼眶顶部的额骨内发生血管囊肿使眼球突出极为少见 ,我院 1998年发现并成功治疗了 1例这样病人 ,现报道如下。患者高××　男　 69岁　住院号 1998- 5 5 2 3　 98年 10月 5日主诉右眼球逐渐向前突出 ,向外侧活动受限 ,来院检查 ,视力右 4 .0 ,左 4 0 (矫正不应 ) ,双眼角膜清晰 ,前房深浅正常 ,虹膜纹理清楚 ,瞳孔等大、等圆 ,直接和间接光反射正常。晶体透明。视乳头和视网膜血管均无异常。Hertel眼球突出计检查 ,右眼球较左眼球突出超过 3 mm。眼眶横断位 CT摄片见右眶外上方额骨内有一个 …     

TAO患者眼眶脂肪组织中脂肪特异性磷脂酶A2 mRNA表达水平分析

目的：分析甲状腺相关眼病(TAO)患者与正常人眼眶脂肪组织中脂肪特异性磷脂酶A2(AdPLA)mRNA 表达水平差异性。

方法：选取2016-12/2017-12在本院进行眼眶减压手术的37例37眼TAO(静止期Ⅲ级)患者作为观察组,选取同期正常眼眶脂肪组织35例35眼为对照组,其来源为美容、眼袋切除手术和上睑下垂矫正手术者; 使用眼球突出计检测观察组与对照组选取脂肪一侧眼球突出度,并计算两组对象BMI状况,使用西门子emotion16排螺旋CT对两组对象眼眶行CT检测,使用Image J检测选取脂肪一侧眼部脂肪体积状况,Real time PCR法检测眼眶脂肪组织内AdPLA mRNA表达状况。

结果：观察组与对照组平均年龄、BMI及性别对比差异均无统计学意义(P>0.05); 观察组患眼内脂肪含量、眼球突出度及组织内AdPLA mRNA表达量分别为32.21±1.85mL、19.97±1.56mm、0.04±0.01高于对照组的24.05±1.64mL、14.07±1.48mm、0.01±0.003,差异均有统计学意义(P<0.05)。

结论：TAO患者眼内脂肪含量、眼球突出度及组织内AdPLA mRNA表达量均比正常人高,TAO患者眼部脂肪组织内AdPLA表达量升高造成了其脂肪水解量降低,脂肪堆积量增大使其眼球突出程度加重。     

眼眶爆裂性骨折Medpor钛网种植体早期整复

目的 探讨Medpor钛网种植体在眼眶爆裂性骨折伴眼球内陷的早期整复手术中的疗效.方法 对18例眼眶爆裂性骨折合并有眼球内陷,外伤后2周施行眼眶修复术,以Medpor钛网种植体作为整复材料,三维CT扫描测量术前眼眶容积变化;Hertel眼球突出计测量术前、术后眼球内陷的程度;所有测量均以对侧正常眼为对照;术后随访6 ～ 12个月.结果 18例眼眶爆裂性骨折眼眶容积较对照眼均有明显增大（t=-20.54,P＜0.01）;术后眼球内陷均矫正,术后6个月11例复视消肖失,2例复视症状改善,复视治愈率84.61％.结论 通过三维CT及计算机辅助技术对眼眶爆裂性骨折伴眼球内陷做早期诊断,早期重建手术疗效好;Medpor钛网种植体在眼眶整复术中是安全、有效的.     

眼眶病患者眼球突出度与眶压比值的研究

目的了解眶内占位性病变为固体、液体或气体时眼球突出度与眶压比值的差异。方法用直接接触式眶压计对５０例眼眶病患者进行眼球突出度及眶压测量,计算眼球突出度与眶压的比值。结果眶内占位性病变为固体时眼球突出度与眶压的比值最低,为交通性液体时最高。结论测量眼球突出度与眶压的比值可为诊断眶内占位性病变的性质提供依据。     

未成年人摘除眼球后眼眶的发育

目的探讨未成年人摘除眼球未植入义眼台的眼眶发育情况。设计回顾性病例系列。研究对象41例未成年时行单眼眼球摘除患者。方法回顾分析患者冠状位眼眶CT扫描影像资料,测量患侧及健侧的眼眶入口面积。主要指标眼眶入口面积。结果摘除眼球侧和健侧眼眶入口面积分别为(10.67±1.41)mm2和(12.03±1.41)mm2(P=0.000)。0~6岁摘除眼球组和7~12岁摘除眼球组两侧眼眶入口面积的差别均有统计学意义(P=0.000、0.018),13~18岁摘除眼球组二者的差别无统计学意义(P=0.09)。配戴义眼片组和未配戴义眼片组无眼球侧眼眶入口面积与健侧眼眶入口面积差存在统计学差异(P=0.004)。结论未成年人摘除眼球后影响该侧眼眶生长发育,摘除眼球时的年龄越小影响越大。摘除眼球后配戴义眼片可改善眼眶的发育。     

眼眶爆裂性骨折伴眼球内陷的眼眶容积测量

目的　测量眼眶爆裂性骨折伴眼球内陷患者眼眶容积的改变量 ,探讨眼眶容积改变量和眼球内陷度数之间的关系。方法　应用CT影像和计算机图像处理技术 ,以及眼眶三维测量方法 ,测量 1 6例单侧眼眶爆裂性骨折伴眼球内陷患者外伤眼及对侧正常眼的眼眶容积 ,并采用Pearson方法进行统计学分析。结果　眼眶爆裂性骨折的眼眶容积增加量和眼球内陷度数呈高度正相关性(r=0 95 ,P <0 0 0 1 ) ,眼眶容积增加 1 0cm3,眼球将内陷约 0 9mm。结论　对眼眶容积进行测量 ,可预测眼眶外伤晚期发生眼球内陷的可能性和程度 ,为确定治疗方案及手术中植入眼眶内填充物的数量及体积提供客观依据。     

改良结膜入路眼眶内下壁减压术治疗轻中度甲状腺相关眼病的临床效果

目的　评价改良结膜入路眼眶内下壁减压术治疗轻中度甲状腺相关眼病的疗效。方法　回顾性分析2017年1月至2018年8月在云南省第二人民医院行改良结膜入路眼眶内下壁减压术治疗的10例（11眼）轻中度甲状腺相关眼病患者。所有患者在术前均给予眼眶水平位、冠状位和矢状位CT检查，测量视力、眼球突出度、复视情况，检查眼外观进行眼前段照相等。将手术前、后眼球突出度，视力以及复视的改善情况作为效果评价指标，对相关数据进行统计和分析。结果　本组11眼术前眼球突出度为（18.94±1.40）mm，术后（15.22±1.46）mm；术后与术前比较，眼球突出度降低（3.72±0.64）mm，差异有统计学意义（t=18.379，P＜0.001）。术前视力为 0.53±0.29，术后为0.62±0.32；术后与术前比较，视力提高0.08±0.10，差异有统计学意义（t=-2.733，P=0.021）。术前复视2例；术后新发生复视2例，均为轻度复视。术前已存在复视的患者，术后复视程度无加重。结论　改良结膜入路眼眶内下壁减压术能有效改善甲状腺相关眼病患者的眼球突出度与视力，术后复视发生概率低，手术切口隐蔽美观，是一种可靠且有效的眶减压术式。     

Comparison of exophthalmos measurements: Hertel exophthalmometer versus orbital parameters in 2-dimensional computed tomography

Objective

To compare the reliability of orbital parameters calculated using 2-dimensional computed tomography (CT) and Hertel exophthalmometry when measuring exophthalmos in normal subjects and in patients with thyroid-associated orbitopathy (TAO).

Measurement of globe position in complex orbital fractures. I. A modification of Hertel's exophthalmometer, using the external auditory canal as a reference point.

Where there has been displacement or removal of the lateral orbital rim or zygomaticomaxillary complex secondary to trauma or surgery, the measure of globe position by the Hertel exophthalmometer is problematic and inaccurate. A modification of Hertel's instrument that uses the external auditory canal (EAC) rather than the orbital rim as reference point has been developed. Measurement of globe position of 120 normal volunteers was obtained with the Hertel and the modified EAC-fixated exophthalmometer. Although the mean absolute difference between right and left measurements for both methods (Hertel mean, 0.36 mm; modified mean, 0.51 mm; n = 120) differed statistically from 0 (p = 0.0001), that difference was not clinically significant. A more meaningful comparison was that of the variability of the two methods. The variance of the Hertel method (0.32) did not differ from the variance of the modified method (0.40; p = 0.06). No statistically significant difference was noted for sex (p = 0.33) or for race (p = 0.11). We believe this instrument to be of practical use in the assessment of enophthalmos or exophthalmos in patients whose facial deformity, trauma, surgery, or disease precludes the use of a rim-based exophthalmometry.     

Measurement of globe position in complex orbital fractures. II. Patient evaluation utilizing a modified exophthalmometer.

Globe position was assessed by both the Hertel exophthalmometer and the modified external auditory canal (EAC)-fixated device in 27 patients with complex orbital fractures (18 tripod and 9 Le Fort fractures). Although 94% of the patients with tripod fractures had relative exophthalmos on the fracture side or no difference between eyes by Hertel exophthalmometry, greater than 30% of the same patients showed relative enophthalmos when measured by the EAC-fixated device. In three of four patients undergoing surgical repair of the orbital floor, modified exophthalmometry showed exophthalmos of greater than or equal to 2 mm postoperatively on the fractured side. The relatively low incidence of enophthalmos in tripod fractures indicates a need for selective orbital floor repair; the uniform exploration of the orbital floor should be discouraged. Multiple comminuted facial fractures (Le Fort II and III) showed a greater variability in globe position and a high frequency (90%) of enophthalmos, suggesting a need for early orbital repair in these patients. EAC-fixated exophthalmometry can provide meaningful information regarding globe position in orbitofacial fracture patients in which orbital rim-based methods are precluded.     

Comparison of unilateral and simultaneous bilateral measurement of the globe position, using the Hertel exophthalmometer

PURPOSE: To assess the effect of simultaneous measurement of the two eyes in Hertel exophthalmometry (i.e., when both readings are taken sequentially, without removing the instrument from the orbital rims) and to find out whether simultaneous measurement would influence the final reading of each eye. METHODS: In this prospective, comparative study, Hertel exophthalmometry was performed on 61 patients by two experienced observers. Only patients with no history of orbital disease were included. Three different measurements were performed on each patient by each observer. Initially, the right eye was measured separately, then the left eye was measured separately, and finally, both eyes were measured together. RESULTS: When the eyes were measured separately, in 30% of cases observers obtained equal readings in both eyes; in 47%, the difference between the two eyes was 1 mm; and in 23%, the difference was 2 mm or more. However, in simultaneous bilateral measurements, in 73% of cases, observers obtained equal readings in both eyes; in 24%, the difference between the two eyes was 1 mm; and only in 3% was the difference 2 mm or greater. Paired t tests showed that the mean difference between measurements of the two eyes was significantly smaller in simultaneous bilateral measurements (p <0.001). Interobserver variation was similar for measurements taken separately on each eye and for simultaneous bilateral measurements. CONCLUSIONS: When both eyes were measured simultaneously with the Hertel exophthalmometer, examiners were inclined to obtain similar readings in both eyes of patients with symmetrical-appearing eyes. The possible bias arising this way may reduce the reliability of Hertel exophthalmometer in relative exophthalmometry.     

Normative data for hertel exophthalmometry in a normal adult black population.

Ocular protrusion data were obtained on 309 black adults using a Hertel exophthalmometer. The mean protrusion value for black men and women was 18.20 and 17.46 mm, respectively. The upper limit of normal was 24.14 and 22.74 mm for males and females, respectively. The differences between base measurement and mean protrusion values of black men and women were significantly different (p less than 0.015). These data are compared with those of adult white subjects and show that blacks have a higher range of normal than whites. The data indicate that the published upper limit of normal (21 mm) for exophthalmos is not appropriate for adult black patients.     

Hertel(三棱鏡)式突眼計的測量準碓性和儀器改進

目的探討Hertel(三棱鏡)式突眼計的設計方案.方法從光學角度對Hertel(三棱鏡)式突眼計進行定性分析.結果光學結構的不合理性造成測量上不可避免的誤差.結論Hertel(三棱鏡)式突眼計的設計存在缺陷并對之提出改進方案.     

Proptosis—Correlation and Agreement between Hertel Exophthalmometry and Computed Tomography

Aim: To determine the correlation and agreement between Hertel exophthalmometry and computed tomography (CT) of the orbits in measuring proptosis.

Materials and Methods: 80 patients (40 normal and 40 with proptosis) were recruited for this study. Exophthalmometry were performed on all of them using the Hertel exophthalmometer and CT. Values and correlations between the modalities were analysed with unpaired t-tests, intraclass correlation coefficients (ICC), and Pearson correlation coefficients (PCC). The Bland–Altman method was used to analyse the agreement between the two modalities.

Results: Hertel exophthalmometer and CT measurements did not differ significantly (p?>?0.05), although exophthalmometry measurements of the normal (14.5?±?2.2?mm) and proptosis groups (20.5?±?3.9?mm) were higher than those obtained from CT (13.9?±?2.4?mm and 20.0?±?3.7?mm, respectively). ICC for both the Hertel exophthalmometer and CT measurements were both 0.99, indicating high intra-observer reliability and reproducibility. PCC between Hertel exophthalmometer and CT measurements in both normal and proptosis groups were strongly correlated (r?=?0.96 and 0.93, respectively, p?=?0.01). The 95% limits of agreement (LOA) between Hertel exophthalmometer and CT measurements for the normal and proptosis groups were ?0.70 to 1.78?mm and ?2.36 to 3.33?mm, respectively.

Conclusion: Although Hertel exophthalmometer and CT measurements are similar and strongly correlated, they do not agree well with each other in the presence of proptosis. The measurements should not be used interchangeably as the differences between them may lead to errors in clinical interpretation.     

New quantitative parameters for CT evaluation of orbitopathy in dysthyroid ophthalmopathy

The new index (c/o ratio) is defined as the content of the orbit divided by the capacity of the bony orbit on the mid-orbital axial CT slice showing the medial and the lateral rectus muscles and optic nerve. Other quantitative parameters such as for exophthalmos and the capacity of bony orbit were also obtained on CT films. These parameters were measured in 474 eyes of patients with dysthyroid ophthalmopathy. The capacity of bony orbit showed large variations among all patients. The average for males was 17.8cm3 and that for females was 16.1cm3. Exophthalmos measurement on CT is more reliable than that by the Hertel exophthalmometer. The new index (c/o ratio) is a very reliable parameter for evaluating orbitopathy in dysthyroid ophthalmopathy. A large c/o ratio (greater than 1.6) was of clinical significance, because approximately 70% of the enlargement of the extraocular muscle observed in older patients (greater than 40 yrs old) was associated with a large c/o ratio (greater than 1.6).     

Clinical exophthalmometry: a comparative study of the Luedde and Hertel exophthalmometers

Exophthalmometry, the quantitative assessment of the position of the globe in the orbit, is a clinically useful measurement. The purpose of this study was to examine the performance of a simple exophthalmometer that would lend itself to accurate and convenient use in clinical practice. In this study, two observers independently performed exophthalmometry on 100 eyes using the Hertel and Luedde instruments. The results were compared between instruments and between observers. There was no statistically or clinically significant difference between measurements taken with the Luedde as compared with the Hertel instrument. The Luedde exophthalmometer has a number of advantages over the Hertel exophthalmometer, and represents a simple, inexpensive and equally reliable means of evaluating clinically the anteroposterior position of the eye in the orbit.