Egbert J E, May K, Kersten R C, Kulwin D R
University of Minnesota, Department of Ophthalmology, Minneapolis, Minnesota 55455-0501, USA.
Ophthalmology. 2000 Oct;107(10):1875-9. doi: 10.1016/s0161-6420(00)00334-1.
To study the clinical presentation, operative findings, and postoperative results of a surgical series of isolated orbital floor fractures in children.
Noncomparative, retrospective, consecutive case series.
Thirty-four patients (34 orbits) less than 18 years of age with isolated orbital floor fractures. Indications for surgery were severe limitation of extraocular ductions, 22 of 34; enophthalmos, 8 of 34: or both, 4 of 34.
Surgical repair.
Cause of fracture, symptoms, clinical signs, radiographic data, operative findings, postoperative results, and complications.
Children older than 12 years of age were more likely to sustain an orbital floor fracture as a result of interpersonal violence than were children less than 12 years of age (P: = 0.020). Sixty-two percent of patients (21 of 34) exhibited pain with eye movements and/or nausea and vomiting. Most had a trapdoor type fracture (21 of 34). The inferior rectus muscle was entrapped in the orbital floor fracture in 69% (18 of 26) of patients with a severe limitation of ocular ductions. Preoperative nausea and vomiting were immediately relieved after surgery. The median time for improvement of preoperative duction deficits and diplopia was 4 days for patients receiving surgery within 7 days and 10.5 days for those undergoing surgery after 14 days (P: = 0.030). Resolution of duction deficits or diplopia was not dependent on time of surgery if performed within 1 month of injury. Loss of vision, worsening of motility, or implant complications did not occur.
Pediatric patients with isolated orbital floor fractures who had pain, nausea, vomiting, and severe limitation of extraocular motility often have direct entrapment of the inferior rectus muscle into the fracture site. Surgical repair rapidly relieved preoperative pain, nausea, and vomiting. For patients with severe limitation of ductions, early surgical repair within 7 days of injury resulted in more rapid improvement of ductions and diplopia than surgery performed later.
研究儿童孤立性眶底骨折手术系列的临床表现、手术发现及术后结果。
非对照、回顾性、连续病例系列。
34例年龄小于18岁的孤立性眶底骨折患者（34只眼眶）。手术指征为眼球运动严重受限（34例中的22例）、眼球内陷（34例中的8例）或两者兼具（34例中的4例）。
手术修复。
骨折原因、症状、临床体征、影像学数据、手术发现、术后结果及并发症。
12岁以上儿童因人际暴力导致眶底骨折的可能性高于12岁以下儿童（P = 0.020）。62%的患者（34例中的21例）表现出眼球运动时疼痛和/或恶心呕吐。大多数为活板门型骨折（34例中的21例）。在眼球运动严重受限的患者中，69%（26例中的18例）的下直肌被困于眶底骨折处。术前恶心呕吐在手术后立即缓解。对于在7天内接受手术的患者，术前眼球运动缺陷和复视改善的中位时间为4天，而在14天后接受手术的患者为10.5天（P = 0.030）。如果在受伤后1个月内进行手术，眼球运动缺陷或复视的恢复不取决于手术时间。未发生视力丧失、眼球运动恶化或植入物并发症。
患有疼痛、恶心、呕吐及眼球运动严重受限的儿童孤立性眶底骨折患者，下直肌常直接陷入骨折部位。手术修复迅速缓解了术前疼痛、恶心和呕吐。对于眼球运动严重受限的患者，受伤后7天内早期手术修复比后期手术能更快改善眼球运动和复视。
