儿童眶壁骨折临床特点及手术治疗

The characteristics and surgery therapy of pediatric orbital fracture

目的探讨儿童眶壁骨折临床特点及手术注意的问题。方法对2—14岁儿童眶壁骨折15例进行回顾性研究，分析其致伤原因，临床表现及伴随症状，骨折部位及影像学表现，眼球突出度、复视像和同视机检查结果。结果致伤原因主要为暴力伤10例，车祸3例，跌伤2例。全部患儿中眶下壁骨折占53．3％（8／15），术前均有复视存在，13例受伤后伴有恶心、呕吐，3例出现眼球内陷。15例全部行眶壁骨折修复术。术后10d，15例术眼均高于或等于对侧眼；5例复视消失，7例减轻，3例较术前加重。术后2个月，15例术眼无内陷，双眼球突出度对称；8例复视完全消失，5例仍残留少量复视，2例复视明显者需作斜视手术调整眼肌。结论儿童眶壁骨折主要以爆裂性眶下壁骨折为主，眼肌及其周围筋膜组织容易嵌顿于骨折处，因此早期恢复眶腔的正常形态和充分分离嵌顿组织后合理填充人工骨片显得更为重要。术后注意恢复和训练患儿的双眼视功能是医生和患儿家属需要注意的一个重要问题。

Objective To analyze clinical features of pediatric orbital fractures and considerations in the surgery procedures. Methods A retrospective research was carried out with 15 pediatric orbital frac- ture patients aged from 2 to 14 years. The injury causes, clinical manifestations, accompanying symptoms, positions of orbital fracture and imaging examinations, standout of eyeballs, data of diplopia images and syn- optophore examinations were analysed. Results Violence injury （10 cases）, traffic accident （3 cases） and fall injury （2 cases） were main causes of orbital fracture. CT showed eight inferior orbital fractures in fifteen pediatric patients（53.3% ）. All of the 15 cases had diplopia, 13 children among them had nausea and vomiting symptoms, and three of them had enophthalmos. All of the pediatric patients were operated. Ten days after operation, fifteen operated eyes were higher than or equal to the contralateral eyes. Diplopia disappeared in five children, alleviated in seven children and deteriorated in three children. Two months af- ter operation, the sign of enophthalmos disappearred and the eyeballs of the two sides were symmetrical in the 15 cases. Diplopia completely disappeared in eight children, remained slightly in five children. Two children with apparent diplopia needed to be operated. Conclusion Pediatric orbital fractures are mostly orbital floor blowout fractures, ocular muscles and fascia tissues are easily entrapped in the fracture fissure. It is very important to recover normal orbital shape, separate entrapped soft tissues adequately and implant Medpor or HA reasonably. In addition, it should be paid attention by doctors and parents to recover and train the functions of injuried ocular muscles.