31例儿童Trapdoor眼眶下壁骨折手术治疗的观察与分析

Observation and analysis of surgical therapy in 31 children with trapdoor-type orbital floor fractures

目的分析儿童Trapdoor眼眶下壁骨折的特点和治疗方法。方法对31例Trapdoor眼眶下壁骨折患儿采用结膜切口入路行眼眶骨折整复术,根据骨缺损面积,27例植入可吸收眶板,4例未使用修复材料。术后指导患儿进行规律眼肌训练,随访12个月。记录患儿手术前后视功能、眼球运动情况、眼球突出度以及眼眶CT扫描结果。结果术后1个月时,受伤后5d内手术者治愈率为90.9%(10/11),5 d后手术者治愈率为65.0%(13/20);术后12个月时,受伤后5 d内手术者治愈率为90.9%(10/11),5 d后手术者治愈率为75.0%(15/20)。所有患儿术后无继发性睑内翻、下睑退缩、眶下神经麻痹发生,未发生植入物感染及排斥反应。结论儿童Trapdoor眼眶骨折确诊后应早期进行手术治疗,术中应用可吸收眶板修复眼眶下壁骨折安全、有效。

Objective To analyze the clinical manifestation and therapeutic efficacy of surgical therapy in children with trapdoor-type orbital floor fracture. Methods Thirty-one children with trapdoor-type orbital floor fractures were included in this study. All CT scans showed line-shaped orbital floor fractures. Eleven cases received surgery within 5 days and 20 cases received surgery 5 days later. All fractures were approached by conjunctival incision. According to the area of bone defects, 27 cases were implanted with absorbable orbital plates, and 4 cases were not. Regular eye muscle training was conducted for 12 months after the operation. Visual acuity, eyeball motility, exophthalmos degree, and CT scan results were recorded before and after surgery. Results One month after the surgery, the cure rate was 90.9 %（10/11）in patients who received surgery within 5 days and 65.0 %（13/20）in patients who received surgery after 5 days.Twelve months after the surgery, the cure rate was 90.9 %（10/11）in patients who received surgery within 5 days and 75.0%（15/20）in patients who received surgery after 5 days. No eyelid entropion, lower eyelid shrinking, infraorbital nerve paralysis, infection or rejection was caused by resorbable implants after operation. Conclusion Trapdoor-type orbital floor fractures in children should be treated as early as possible. Resorbable implants were safe and effective in restoring trapdoor-type orbital floor fractures.