Correlative Study Of Diabetic Patients And Prognosis Of Patients With Orbital Blowout Fracture Under Nasal Endoscope

Purpose:Orbital fracture refers to the trauma of multiple fractures in the middle of the face caused by external force impact on the eye.According to the nature of the fracture,it can be roughly divided into: blow-out orbital wall fracture and blow-in orbital wall fracture,of which the most common type is the blow out orbital wall fracture.Today,surgical repair is the most ideal method for the treatment of blow-out orbital wall fracture.The use of nasal endoscope combined with traditional approach or direct transnasal approach has the advantages of directly looking at the location of orbital wall fracture,directly evaluating the injury and making surgical plans.For patients with diabetes,because of microvascular disease,leading to poor tissue regeneration ability,in the process of surgical treatment is more prone to bleeding,resulting in postoperative recovery is relatively slow,and more prone to complications.However,the prognosis of orbital wall fracture patients with diabetes mellitus after endoscopic orbital wall repair surgery is still unclear.The purpose of this study is to analyze the recovery of traumatic orbital fracture patients with diabetes undergoing endoscopic orbital wall repair surgery,and to explore the impact of diabetes on the prognosis of orbital wall fracture patients.Methods: 50 cases of traumatic orbital fracture patients who were treated in Qingdao municipal hospital or Qingdao eye hospital from January 2019 to June 2020 were collected.Among them,14 patients with diabetes mellitus were set as the observation group,and the remaining 36 patients without diabetes mellitus were set as the control group.All patients underwent orbital wall repair under nasal endoscope.The age,gender,duration of diabetes,duration of orbital wall fracture,and area of orbital wall defect were recorded.Blood glucose level,glycosylated hemoglobin level,exophthalmos,eye movement,diplopia,complications,visual acuity and recovery time were observed before operation and 1 day,1 week,1 month,3 months and 6 months after operation.The levels of IL-6 and TNF-α were detected before operation,during operation,1 day and 1 week after operation.The orbital CT was regularly reviewed to confirm the changes of implant and orbital contents.The patients were followed up for 6 months.Results: there were no significant differences in sex composition,age,course of diabetes,course of orbital wall fracture and orbital wall defect area between the observation group(n = 14)and the control group(n = 36)(all P > 0.05).There were no significant differences in exophthalmos,eye movement,diplopia and visual acuity between the two groups(all P > 0.05)The average recovery time of the observation group was(10 ± 3.2)days,and that of the control group was(7 ± 2.1)days.There were significant differences in the levels of IL-6 and TNF-α between the observation group and the control group(all P < 0.05).There were 2 cases of postoperative cavity infection,1 case of postoperative cavity adhesion and 3 cases of polypoid changes in the observation group,and 1 cases of postoperative polypoid changes in the control group.Conclusion: diabetes can affect the prognosis of orbital wall fracture surgery,and the degree of influence is related to blood glucose level,IL-6 and TNF-α level.Controlling blood glucose can improve the prognosis,reduce complications,shorten the recovery time and improve the surgical effect.