Wei Leslie A, Durairaj Vikram D
Department of Ophthalmology, University of Colorado, School of Medicine, Denver Colorado, USA.
J AAPOS. 2011 Apr;15(2):173-80. doi: 10.1016/j.jaapos.2011.02.005.
To summarize the unique aspects of orbital floor fractures in children with regard to clinical presentation, management, and outcomes.
MEDLINE was searched using PubMed for English-language articles on orbital floor fractures in children. All 154 indexed articles pertaining to floor fractures in patients under 18 years of age in PubMed were reviewed. Studies looking at primarily complex fractures and case reports and studies that included pediatric patients but did not analyze them separately were excluded. Overall, 25 studies were included for the review.
Inferior trapdoor fractures with muscle and soft tissue incarceration are the most common type of orbital fracture in children (27.8%-93%). They often present uniquely with severely restricted extraocular motility and diplopia (44%-100%), nausea and vomiting (14.7-55.6%), and minimal signs of external trauma. The majority of studies (83%) that analyzed time to surgery in relation to outcomes found that children who present early after initial injury and undergo prompt surgical repair appear to recover faster and have better postoperative motility than those receiving delayed treatment.
Our understanding of pediatric orbital floor fractures continues to evolve. For young patients with symptomatic diplopia with positive forced ductions, soft tissue entrapment confirmed by computed axial tomography, and/or trapdoor fracture plus restricted ocular movement, having surgery within 2-5 days has been shown to result in better postoperative outcomes. It is recommended that surgery be considered within 48 hours of diagnosis. Long-term prospective studies are still needed to further characterize orbital floor fractures in children.
总结儿童眶底骨折在临床表现、治疗及预后方面的独特之处。
利用PubMed在MEDLINE中检索关于儿童眶底骨折的英文文章。对PubMed中所有154篇索引文章进行了回顾，这些文章涉及18岁以下患者的眶底骨折。排除主要研究复杂骨折的研究、病例报告以及虽纳入儿科患者但未单独分析的研究。总体而言，纳入25项研究进行综述。
伴有肌肉和软组织嵌顿的下方活板门骨折是儿童最常见的眶骨折类型（27.8%-93%）。它们常具有独特的表现，包括严重受限的眼球运动和复视（44%-100%）、恶心和呕吐（14.7%-55.6%），以及轻微的外部创伤体征。大多数分析手术时机与预后关系的研究（83%）发现，受伤后早期就诊并接受及时手术修复的儿童，似乎比接受延迟治疗的儿童恢复得更快，术后眼球运动也更好。
我们对儿童眶底骨折的认识在不断发展。对于有症状性复视、被动牵拉试验阳性、经计算机断层扫描证实有软组织嵌顿和/或活板门骨折加眼球运动受限的年轻患者，在2-5天内进行手术已被证明能带来更好的术后预后。建议在诊断后48小时内考虑手术。仍需要长期前瞻性研究来进一步明确儿童眶底骨折的特征。
