未成年人眶壁爆裂性骨折的临床特点及治疗分析

Clinical characteristics and management of juvenile orbital blow-out fracture

目的分析未成年人不同年龄眶壁爆裂性骨折的临床特点与骨折类型的相关性，探讨少年儿童眶壁骨折的治疗方案：方法选取18岁以下眶壁爆裂性骨折患者69例，5～14岁组23例和15～18岁组46例。观察术前眼位和复视情况，眼球内陷程度和眼球运动，CT影像特点表现和术中所见，术后眼位、眼球内陷和眼球运动恢复情况。结果5～14岁组伤后出现恶心、呕吐，眼球垂直运动受限的构成比高于15。18岁组（P均〈0．05）。5-14岁组眼球无内陷的构成比高于15～18岁组（P〈0．05）。5～14岁组眶下壁活板门样（trapdoor）骨折的构成比高于15～18岁组（P〈0．05）。CT显示为眶下壁线性骨折的20例患者术中发现16例骨折区呈trapdoor表现，下直肌嵌夹于骨折区呈紫红色肿胀。结论5～14岁儿童发生眶下壁trapdoor骨折的风险较高，确诊后早期手术对促进眼外肌功能恢复和减少复视残留具有重要意义。

Objective To analyze the relevance of clinical features and the fracture types among dif- ferent ages in juvenile orbital blow-out fractures And to evaluate the management of pediatric orbital fractures. Methods Sixty-nine patients less than 18 years of age with isolated orbital blow-out fractures were included in this study.All patients were divided into two groups： 23 cases were 5 to 14 years of age and 46 cases were 15 to 18 years of age.Position of the eyeball, degree of enophthalmos,limitation of extraocular ductions, diplopia, computer tomography data, operative findings, postoperative results were observed.Results The main causes of fracture in 5 to 14 years of age group were collision and fall,while in 15 to 18 years of age group were vehi- cle accident and violence （P 〉0.05 ）.There show larger constituent ratios of Nausea/vomiting and vertical duction limitation in 5 to 14 years of age group than that in 15 to 18 years of age group （P 〈0.05）.Children between 5 to 14 years of age had less chance of enophthalmos than children between 15 to 18 years of age （P〈 0.05 ）.But they were more likely to have an orbital floor trapdoor type fracture （P〈0.05）.Operative findings showed 16 of 20 fracture defects were trapdoor type which were all detected as linear type fracture by computer tomography images.The inferior rectus muscle entrapped in orbital fracture site was amaranth and swelling. Children between 5 to 14 years of age seemed to have a higher probability and a more severer degree of infraduction defect than children 15 to 18 years of age postoperatively.Two patients between 5 to 14 years of age got an aggravating extraocular ductions limitation and diplopia once again in 1 week postoperatively.Conclusion There shows an increasing risk of sustaining an orbital floor trapdoor type fracture in children between 5 to 14 years of age.Prompt surgical intervention could improve extraocular ductions and reduce residue diplopia.