Yang Jae Wook, Woo Jong Eun, An Jae Hwan
Department of Ophthalmology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
Department of Ophthalmology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, Republic of Korea.
J Craniomaxillofac Surg. 2015 May;43(4):444-7. doi: 10.1016/j.jcms.2015.01.010. Epub 2015 Jan 27.
Orbital trapdoor fractures are uncommon but more frequent in children and adolescents. Orbital trapdoor fractures have been discussed in many previous reports, early treatment has been advocated but there is controversy over treatment policy and surgical outcomes. Our retrospective study analyzed the surgical outcomes of orbital trapdoor fracture in children and adolescents to investigate the appropriate timing of treatment and the relationship between severity of extraocular muscle movement (EOM) limitation before the operation and the period of recovery after operation.
A total of 44 children and adolescents with orbital wall fractures were operated on from 2009 to 2013. This study included 25 patients who underwent surgery for orbital trapdoor fractures; age range 9-18 years (mean age 14.0). We investigated the interval from trauma to surgery, the period of full EOM recovery after operation and the correlation between these factors, retrospectively.
The mean follow-up duration was 90.2 days. At follow-up, nine out of ten patients who underwent surgery within 24 h (Group 1) had full EOM recovery, with a mean recovery time of 25.1 days; five out of six patients who underwent surgery within 24-72 h (Group 2) had full EOM recovery with a mean recovery time of 60.2 days; and seven out of nine patients who underwent surgery after 72 h (Group 3) had full EOM recovery with a mean recovery time of 67.6 days. There was no statistical difference in the operation success rates between the groups. Also, the four patients that not completely recovered EOM had a mild EOM limitation below grade -1.
In our study, we found that patients with orbital trapdoor fractures can recover full EOM regardless of the interval from trauma to surgery. Therefore, we suggest that appropriate surgical technique is important in the treatment of patients with orbital trapdoor fractures, in addition to the urgent surgery recommended for these fractures in a pediatric population. Furthermore, we expect a good prognosis following the treatment of orbital trapdoor fractures if appropriate surgical techniques are used, even if a relatively long time has passed after the trauma.
眼眶活板门骨折并不常见，但在儿童和青少年中更为频发。此前已有许多报告对眼眶活板门骨折进行了讨论，虽然提倡早期治疗，但在治疗策略和手术效果方面仍存在争议。我们的回顾性研究分析了儿童和青少年眼眶活板门骨折的手术效果，以探讨合适的治疗时机以及术前眼外肌运动（EOM）受限程度与术后恢复时间之间的关系。
2009年至2013年期间，共有44例眼眶壁骨折的儿童和青少年接受了手术。本研究纳入了25例行眼眶活板门骨折手术的患者；年龄范围为9至18岁（平均年龄14.0岁）。我们回顾性调查了受伤至手术的间隔时间、术后EOM完全恢复的时间以及这些因素之间的相关性。
平均随访时间为90.2天。随访时，在伤后24小时内接受手术的10例患者中有9例（第1组）EOM完全恢复，平均恢复时间为25.1天；在伤后24至72小时内接受手术的6例患者中有5例（第2组）EOM完全恢复，平均恢复时间为60.2天；在伤后72小时后接受手术的9例患者中有7例（第3组）EOM完全恢复，平均恢复时间为67.6天。各组之间的手术成功率无统计学差异。此外，4例EOM未完全恢复的患者存在轻度EOM受限，低于-1级。
在我们的研究中，我们发现眼眶活板门骨折患者无论受伤至手术的间隔时间如何，均可实现EOM完全恢复。因此，我们建议，对于眼眶活板门骨折患者的治疗，除了儿科人群中针对这些骨折推荐的紧急手术外，合适的手术技术也很重要。此外，我们预计，如果采用合适的手术技术，即使在受伤后经过了较长时间，眼眶活板门骨折的治疗也会有良好的预后。
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