Garcia Tracey A, McGetrick Betty A, Janik Joseph S
Department of Pediatric Surgery, The Children's Hospital, University of Colorado Health Sciences Center Denver, Colorado, USA.
J Trauma. 2005 Jul;59(1):169-74. doi: 10.1097/01.ta.0000174513.79115.7a.
Few studies document the variety of ocular injuries encountered in children after major trauma. This study was performed to determine the type and frequency of ocular injuries in a large population of children with major trauma.
All children with ocular and adnexal injuries (n = 7497) among 96,879 children registered in the National Pediatric Trauma Registry (NPTR) were analyzed. Children were stratified for Injury Severity Score (ISS is a method for categorizing patients with multiple injuries in which an ISS > 15 is considered major trauma), age, sex, injury, protective restraint, vision threatening injury, and basilar skull fracture.
Nearly 8% of the children in the NPTR sustained an ocular injury. These children had one or more injuries to one or both eyes and/or the ocular adnexa for an average of 1.3 ocular injuries per child. Three-fourths (75%) of the children with an ocular injury had an ISS < or = 15 and one-fourth (25%) had an ISS > 15. Among children with an ISS > 15 the most common injuries were orbital wall fracture (59%) and contusion of the eye and ocular adnexa (18%). Among these same children with an ISS > 15, the percent of orbital wall fractures, injuries to the optic nerve, and injuries to the other ocular cranial nerves doubled while the percent of basilar skull fractures tripled when compared with children with an ISS < or = 15. Penetrating injuries of the globe were significantly lower in children with an ISS > 15 than in children with an ISS < or = 15. Over 70% of the children with an eye injury and an ISS > 15 sustained injury in an accident involving a motorized or non motorized vehicle, and over 75% of those who could have been restrained, were not restrained.
Children with an ocular injury sustained during major trauma (ISS > 15) are more likely to have a basilar skull fracture, orbital wall fracture, and a contusion of the eye and/or the ocular adnexa as compared with children with ISS < or = 15. Children with any of these injuries sustained during major trauma should be afforded prompt ophthalmologic evaluation to uncover injury to components of the visual system.
很少有研究记录儿童在遭受重大创伤后眼部损伤的种类。本研究旨在确定大量遭受重大创伤儿童的眼部损伤类型及发生率。
对国家儿科创伤登记处（NPTR）登记的96,879名儿童中所有有眼及附属器损伤的儿童（n = 7497）进行分析。根据损伤严重程度评分（ISS是一种对多发伤患者进行分类的方法，ISS>15被视为重大创伤）、年龄、性别、损伤类型、是否使用保护约束装置、是否有威胁视力的损伤以及是否有颅底骨折对儿童进行分层。
NPTR中近8%的儿童遭受了眼部损伤。这些儿童一只或两只眼睛和/或眼附属器有一处或多处损伤，平均每名儿童有1.3处眼部损伤。四分之三（75%）有眼部损伤的儿童ISS≤15，四分之一（25%）的儿童ISS>15。在ISS>15的儿童中，最常见的损伤是眶壁骨折（59%）以及眼和眼附属器挫伤（18%）。与ISS≤15的儿童相比，在这些ISS>15的儿童中，眶壁骨折、视神经损伤和其他眼颅神经损伤的比例翻倍，而颅底骨折的比例增至三倍。ISS>15的儿童眼球穿通伤明显低于ISS≤15的儿童。超过70%有眼部损伤且ISS>15的儿童在涉及机动车或非机动车的事故中受伤，超过75%本可使用保护约束装置的儿童未使用。
与ISS≤15的儿童相比，在重大创伤（ISS>15）期间遭受眼部损伤的儿童更有可能发生颅底骨折、眶壁骨折以及眼和/或眼附属器挫伤。在重大创伤期间遭受上述任何一种损伤的儿童都应立即接受眼科评估，以发现视觉系统各组成部分的损伤。
