伴或不伴下直肌箝闭的trapdoor眼眶骨折的临床特征

Clinical features of orbital-floor trapdoor fracture with or without inferior rectus muscle incarceration

目的研究伴或不伴有下直肌箝闭的trapdoor眶底骨折的临床特征。方法回顾性分析2008年1月至2015年12月在深圳市眼科医院确诊为trapdoor眶底骨折并行眼眶壁骨折整复术的20例儿童和青年患者的临床资料,根据CT图像和术中所见将患者分为两组:伴或不伴有下直肌箝闭组。对两组术前术后的症状、CT图像、手术记录和随访结果进行比较。结果不伴下直肌箝闭组的年龄、就诊时间和手术时间分别为(8.91±5.32)岁、(7.64±8.24)d、(9.00±8.39)d,伴下直肌箝闭组分别为(12.44±4.69)岁、(9.56±6.62)d、(10.78±6.44)d,两组相比差异均无统计学意义(均为P>0.05)。但伴有下直肌箝闭的trapdoor眼眶骨折表现为严重的眼球上转受限-3.89±0.33、明显下转受限-2.44±0.73和严重的被动上转受限-4。而不伴有下直肌箝闭者表现为轻至中度上转受限-1.91±0.30、轻度被动上转受限-1.09±0.30。除了伴或不伴有下直肌箝闭外,二组其他CT图像相似。结论伴有严重的眼球上转受限、中度及以上眼球下转受限,及严重的被动上转受限的trapdoor眼眶骨折提示有下直肌箝闭。轻至中度眼球上转受限和轻度被动上转受限,下转无明显受限者提示仅为脂肪结缔组织嵌顿。

Objective To fracture with or without inferior study the clinical features rectus muscle incarceration. of orbital-floor trapdoor Methods This was a retrospective review study. From January 2008 to December 2015,20 children and ado- lescents with orbital-floor trapdoor fracture were seen in Shenzhen Eye Hospital. The patients were classified into two groups, trapdoor fracture with or without muscle incar- ceration,according to computed tomography （CT） images and intraoperative findings. Pre- and post-operative signs and symptoms, CT images,intraoperative findings and fol- low-up results of the two groups were compared. Results The mean age, interval to presentation, and interval to surgery of patients without muscle incarceration were （ 8.91 ＋_ 5.32 ） days, （ 7.54 _＋ 8.24 ） days, and （ 9.00 ＋_ 8.39 ） days, patients with muscle in- carceration were （ 12.44 _＋ 4.59 ） days, （ 9.55 _＋ 6.62 ） days, and （ 10.78 _＋ 6.44 ） days, re- spectively,there was no significant difference between the two groups （ all P 〉 0, 05 ）. Trapdoor fracture with muscle incarceration showed more severe motility restriction in up gaze - 3.89 ＋ 0.33 and moderate motility restriction in down gaze - 2.44 _＋ 0.73, marked limitation to sursumduction -4, whereas fracture without muscle incarceration showed mild to moderate motility restriction in up gaze - 1.91 _＋ 0.30, mild limitation to sursumduction - 1.09 _＋ 0.30, no motility restriction in down gaze. The other CT images were similar between two groups except with or without muscle incarceration. Con- c｜usion Orbital trapdoor fracture patients with severe motility restriction in up gaze and moderate or higher motility restriction in down gaze,plus marked limitation to sur- sumduction are suggested to have inferior rectus muscle incarceration, with mild to moderate motility restriction in up gaze, mild limitation to sursumduction, Nno obvious motility restriction in down gaze are suggested to have connective tissue septa entraped only.