儿童嵌顿性眶下壁骨折的手术及被动牵引训练

Surgery and passive traction training in children with incarcerated infraorbital wall fracture

目的:观察儿童嵌顿性眶下壁骨折手术及被动牵引训练的效果。方法:回顾性分析山西大医院2016年1月至2018年12月儿童嵌顿性眶下壁骨折26例(26眼)的临床资料。术前行超薄层CT+3D成像技术确定骨折范围及眼外肌嵌顿情况,术中进行手术显微镜下眶壁骨折修补术。术前分为两组:伤后≤5天手术(A组)和伤后>5天手术(B组)各13例(13眼)。术后再分两组:主动眼球运动+被动牵引训练(C组)和只做主动眼球运动而未做被动牵引训练(D组)各13例(13眼)。随访6个月,观察术后被动牵引训练的效果。结果:A组术后眼球运动功能、眶下神经感觉恢复的情况均优于B组(χ^2=10.14,6.02,P=0.009,0.015);C组术后眼球运动功能的恢复优于D组(χ^2=6.410,P=0.015)。结论:儿童嵌顿性眶下壁骨折早期手术及术后的被动牵引训练对眼球运动功能及眶下神经感觉功能的恢复至关重要。

Objective To obsence the efficacy of surgery and passive traction training in children with incarcerated infraorbital wall fracture.Methods The clinical data of 26 eyes of 26 cases of children with incarcerated infraorbital wall fracture from Jan.2016 to Dec.2018 in Shanxi Dayi Hospital were retrospectively analyzed.The range of fracture and incarceration of extraocular muscles were determined with ultrathin-layer CT scanning and 3D imaging before surgery.The orbital wall fracture was repaired under microscope during surgery.Before surgery,the patients were divided into two groups,with 13 eyes of 13 cases in each group.Group A underwent surgery within 5 days after trauma and group B underwent surgery above 5 days after trauma.After surgery,the patients were divided into two groups including group C with active eye movement and passive traction training,and group D with only active eye movement without passive traction training.The followed-up time was 6 months.The efficacy of passive traction training after surgery were observed.Results The recovery of ocular motor function and infraorbital nerve sensation in group A was better than that in group B(χ2=10.14,6.02,P=0.009,0.015).The recovery of ocular motor function in group C was better than that in group D(χ2=6.410,P=0.015).Conclusion Early surgery and passive traction training of incarcerated infraorbital wall fracture in children are very important for the recovery of ocular motor function and infraorbital nerve sensory function.