Evaluation of Factors Influencing the Effectiveness of Surgical Rehabilitation of Patients with Orbital Wall Fractures
Rehabilitation of patients with orbital wall fractures should be aimed at eliminating all the negative consequences of these injuries, including diplopia and post-traumatic enophthalmos. The use of digital technology allows to ensure high accuracy of restoration of the anatomical shape of the orbit. Nevertheless, some patients retain the residual effects of these disorders. The purpose of the study. To assess the clinical significance of factors that may affect the effectiveness of functional rehabilitation of patients with orbital wall fractures, after anatomically accurate reconstruction using patient-specific implants. Materials and methods. The study included 39 patients with post-traumatic wall defects who underwent anatomically accurate reconstruction of the orbit with application of patient-specific implants. All patients were examined before and after treatment according to a standard algorithm: collection of complaints, assessment of local status, visual acuity, diplopia and oculomotor disorders as well, as Hertl’s exophthalmometry and computed tomography. Results. A multifactor logistic regression model was developed to determine the factors that could affect the results of rehabilitation of patients. It revealed a significant influence of time between injury (p=0.01) and orbital reconstruction, as well as the presence of clinical and radiological signs of oculomotor muscle damage (p=0.03). Conclusions. The use of patient-specific implants in the reconstruction of the orbit in patients with post-traumatic orbital wall defects allows to eliminate post-traumatic enophthalmos in 92.1% and diplopia in 78.9% of cases. However, even the exact restoration of the orbital volume and its shape it did not allow to achieve full rehabilitation among all patients included in the study. The frequency of diplopia and enophthalmos in both the immediate and long-term follow-up depended on the time of surgery. Orbital reconstruction later than 1 month after injury significantly reduced the integrated clinical outcome (p=0.002). The presence of clinical and radiological signs of oculomotor muscle damage, diagnosed in 44.7% of patients with orbital wall defects can be considered as negative prognostic factor in the treatment of orbital wall defects. Their presence significantly increased the frequency of post-traumatic diplopia and the time of rehabilitation of this group of patients (p=0.001).