未成年人Trapdoor眶下壁骨折的临床特点与治疗预后

The clinical characteristics and surgical prognosis of pediatric trapdoor fracture of orbital floor fractures

【摘要】目的探讨未成年人Trapdoor眶下壁骨折的临床表现和手术预后，为今后临床工作提供依据和指导。方法临床病例回顾性研究。对2005年1月至2014年12月在天津市眼科医院就诊的Trapdoor眶下壁骨折未成年患者45例（3-18岁）临床资料，眶壁骨折修复术后随访6~9月。结果未成年人Trapdoor眶下壁骨折患者在同期同年龄段眶骨骨折患者中占41．3％，致伤原因依次为：意外摔伤或碰伤、袭击伤害，车祸。双眼视物重影是伤后主要就诊症状（97．8％），51．1％患者伤后出现恶心呕吐等眼-心反射。100％患者有不同程度眼球运动受限，原在位眼位与眼球运动障碍分级构成比存在统计学意义（x^2=11．18，P=0．025）。CT扫描检查显示43例（95．6％）肌肉组织嵌夹于骨折缝隙。末次随访，21例眼球运动障碍完全恢复，复视完全消失；17例仅周边视野存在复视；7例功能视野有复视。伤后≤5d与伤后6～14d手术组、伤后≤5d与伤后〉14d组末次随访双眼视觉恢复情况差异有统计学意义（x^2=7．08，P=0．029；x^2=7．55，P=0．023）。伤后≤5d行手术治疗，患者术后获得健全双眼视觉比例更高。结论未成年人眶下壁Trapdoor眼眶骨折发生率高，复视、眼球运动障碍、恶心呕吐等眼心反射表现是重要临床表现。眼眶骨折修复手术解除限制因紊恢复肌肉血液供应，可以改善眼球运动障碍、消除复视，特别是早期手术（≤伤后5d）显著增加患者术后获得健全双眼视觉机会。

Objective To investigate the clinical features and surgical prognosis of pediatric trap- door fracture of orbital floor fractures. Methods A retrospective analysis. The clinical data of 45 pa- tients with trapdoor fracture involving orbital floor were collected, aging 3-18 years old. Each pa- tient was followed-up for 6-9 months after orbital surgery. Results Forty-five （41.3%） cases had trap- door fracture involving orbital floor in all 109 children with orbital fractures. Diplopia was noted in 97.8% patients, ocular-heart reflex including nausea and vomiting in 51.1% patients, extra-ocular mus- cle limitation in all the patients. There were significant differences in the constituent ratios of ocular alignment in the primary position in different scales of ocular motilities （x^2=11.18, P =0.025）. For- ty-three （95.6%） cases had soft tissue entrapment confirmed by CT scan. In the final visiting, 21 cas- es obtained full ocular motilities and no diplopia; 17 cases had residual diplopia only in peripheral visual field; 7 cases remained diplopia in the primary and reading position though ocular movements had been improved a lot. Compared with the groups of patients who underwent surgeries during 6-14 days after injuries and 14 days and more after initial injuries, the patients who underwent prompt orbital surgeries within 5 days after trauma appeared to get better ocular movement and bin- ocular single vision x^2=7.08, P =0.029; x^2=7.55, P =0.023）. Conclusions Trapdoor fracture involves the floor orbit, frequently occurs in children. The most important characteristics include symptomatic diplopia with restrictive ocular movement, ocular-heart reflex and soft tissue entrapment confirmed by CT scan. The patients who undergo prompt surgeries have better ocular movement and binocular single vision.