儿童“白眼”爆裂性眶骨折的临床特点与治疗效果

The clinical characteristics and therapeutic effect of ＂white-eyed＂ blowout orbital fracture in children

目的探讨儿童“白眼”（无明显结膜下出血或眼睑皮下淤血者）爆裂性眶壁骨折的临床表现和手术治疗效果。方法回顾性分析18岁及以下儿童“白眼”爆裂性骨折59例的临床资料，骨折修复术后随访6—9个月。结果儿童“白眼”爆裂性骨折患者占同年龄段眶骨骨折患儿的54．1％。致伤原因依次为：意外摔伤或碰伤、袭击伤害，车祸。复视是伤后主要症状（56例，占94．9％）。伤后出现恶心呕吐等眼一心反射症状者30例，占50．8％。100％患儿有不同程度的眼球运动受限，原在位眼位情况与眼球运动障碍分级构成比情况存在显著差异（P=0．00）。下壁骨折45例（76．3％）居首位。3—13岁组下壁骨折占85．0％明显多于14—18岁组（57．9％）（P=0．02）。末次随访，25例（42．4％）复视完全消失；24例（40．7％）周边视野存在复视；10例（16．9％）原在位和阅读眼位有复视。伤后不同时间手术者术后双眼视觉恢复情况有差异（P=0．03），≤5d手术者术后获得健全双眼视觉比例最高（71．4％）。结论“白眼”爆裂性骨折儿童发生率高，眶下壁受累居多，眼外肌易被嵌塞夹持，但外观损伤表现不明显，临床上容易延误诊断。复视、眼球运动障碍及恶心呕吐等眼心反射症状是重要的临床表现。眼眶骨折修复手术，特别是早期（伤后5d及以内）手术者多可改善眼球运动障碍、消除复视。

Objective To investigate the clinical characteristics and surgical efficacy of ＂white- eyed＂ （ without obvious ecchymosis of conjunctiva and eyelid） blowout fracture in children. Methods The clinical data of 59 patients with ＂white-eyed＂ blowout orbital fractures, aging 3 - 18 years old, were retrospectively analyzed. The follow-up time was 6 - 9 months after the repair surgery for fracture. Results Fifty-nine （54.1%） cases had ＂white-eyed＂ blowout orbital fracture in 109 children with orbital fractures. The main causes were accidental tumble, assault and car accident. Diplopia was noted in 56 patients accounting for 94.9% , ocular-heart reflex including nausea and vomiting was in 30 patients accounting for 50.1% and ocular motility muscle limitation was in all the patients. There were statistically significant differences in the grading constituent ratios of ocular dyskinesia between the primary position and different scales of ocular motilities （P = 0.00）. Proved by CT scan, the inferior orbital wall fracture was the most type and occurred in 45 cases （76.3%）. Children aging less than 14 years old were more likely to have the inferior orbital wall fracture accounting for 85.0% , which was more than that 57.9% of children aging 14 - 18 years old （ P = 0.02 ）. The final visiting was at 6 - 9 months after the surgery. Twenty-five cases （42.4%） had full ocular motilities and no diplopia. Twenty-four cases （40.7%） had residual diplopia only in peripheral visual field. Ten cases （ 16.9% ） remained diplopia in the primary and reading position though ocular movements improved a lot. There were statistically significant differences in the constituent ratios of binocular single vision among the cases who underwent the surgery at different surgical time （ P = 0.03 ）. The patients （71.4%） who underwent prompt orbital surgeries within 5 days after initial trauma appeared to have better ocular movement and binocular single vision. Conclusion White-eyed blowout orbital fracture frequently occurs in children and mainly involves the inferior orbital floor. The most important characteristics of white-eyed blowout orbital fracture include symptomatic diplopia with restricted ocular movement, ocular- heart reflex and soft tissue entrapment confirmed by CT scan. The patients who underwent prompt surgeries within 5 days had better ocular movement and binocular single vision.