儿童Trapdoor眼眶骨折23例治疗分析

Clinical analysis after treatment of 23 orbital Trapdoor fracture cases

目的 分析儿童Trapdoor眼眶骨折特殊性及治疗方法,为临床诊治积累经验.方法 回顾性分析2012年11月至2014年7月就诊于大连医科大学附属第二医院眼科确诊为儿童Trapdoor眼眶骨折23例患者资料,采用结膜切口入路行眼眶骨折整复术,根据骨缺损面积,16例植入可吸收材料,7例未使用修复材料,记录患儿手术前后视功能、复视、眼球运动情况、眼球突出度以及行眼眶CT扫描,术后规律眼肌训练,随访6个月.结果 23例患者手术前后视力差异无统计学意义（P＞0.05）,术前21例复视,20例眼球运动受限,2例眼球内陷,术前CT显示眶壁骨折及软组织嵌顿;术后6个月,患者眼球凹陷均矫正,2例患者残留复视、眼球上转受限,其余患者均矫正,CT显示组织解剖复位.结论 儿童Trapdoor眼眶骨折是一类骨缺损面积小、线性的青支样骨折,眼球转动受限是其特征性临床表现.对于牵拉试验无效的患者需要48 h内手术,推荐使用结膜切口入路,修复骨缺损时优先采用可吸收骨板,对于没有骨缺损的病例可仅将眶壁解剖复位,不需要填充人工材料.

Objective To analyse treatment modalities for Orbital Trapdoor Fractures based on clinical data.Methods Clinical data of orbital trapdoor fractures diagnosed at the Second Hospital of Dalian Medical University between November 2012 and July 2014 were retrospectively analysed.23 cases of orbital trapdoor fracture were included.All fractures were approached transconjunctivally.For 16 cases,absorbable material was chosen to reduce and rigidly fix the fractures while for 7 cases,the bone and soft tissue were just reduced to anatomical positions.Efficacy of either treatment modality was assessed by reviewing CT scans as well as clinical manifestations of diplopia,enophthalmos,eyeball motility with a 6 months follow-up.Results 23 cases of patients before and after surgery no statistic difference in visual acuity.Pre-operatively,21 patients had diplopia,20 had motility limitation while 2 had enophthalmos.Post-operatively,all cases of enophthalmos were repaired.Only 2 patients has residual diplopia and limitation of eyeball motility for up gaze.Post-operative CT scans show proper orbital reconstruction with anatomic reduction of herniated orbital soft-tissue and fracture fixation.Conclusion Orbital trapdoor fracture is a special type of small bone defect、line-shaped、green-stick fracture.The patients can have the special manifestation of motility limitation.For the cases which the forced-duction test is ineffective,always need emergent surgery within 48 hours.Transconjunctival approach is the proper choice,during reduction and fixation of the fracture,we can use absorbtable material or just put the bone and soft tissue on the anatomic position.