Hsieh Pei-Ju, Liao Han-Tsung
Division of Traumatic Plastic Surgery, Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital at LinKou, Chang Gung University College of Medicine, Taoyuan City 333, Taiwan.
College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan.
Children (Basel). 2022 Mar 11;9(3):398. doi: 10.3390/children9030398.
Orbital trapdoor fracture occurs more commonly in pediatric patients, and previous studies suggested early intervention for a better outcome. However, there is no consensus on the appropriate timing of emergent intervention due to the insufficient cases reported. In the current retrospective study, we compared the outcomes of patient groups with different time intervals from injury to surgical intervention and entrapment content. Twenty-three patients who underwent surgery for trapdoor fracture between January 2001 and September 2018 at Chang Gung Memorial Hospital were enrolled. There was no significant difference in diplopia and extraocular muscle (EOM) movement recovery rate in patients who underwent surgery within three days and those over three days. However, among the patients with an interval to surgery of over three days, those with muscle entrapment required a longer period of time to recover from EOM movement restriction ( = 0.03) and diplopia ( = 0.03) than those with soft tissue entrapment. Regardless of time interval to surgery, patients with muscle entrapment took longer time to recover from EOM movement restriction ( = 0.036) and diplopia ( = 0.042) and had the trend of a worse EOM recovery rate compared to patients with soft tissue entrapment. Hence, we suggested that orbital trapdoor fractures with rectus muscle entrapment should be promptly managed for faster recovery.
眶壁陷窝骨折在儿科患者中更为常见，以往的研究表明早期干预可获得更好的预后。然而，由于报告的病例不足，对于紧急干预的合适时机尚无共识。在当前的回顾性研究中，我们比较了从受伤到手术干预的不同时间间隔以及不同嵌顿内容物的患者组的预后。纳入了2001年1月至2018年9月在长庚纪念医院接受眶壁陷窝骨折手术的23例患者。受伤后三天内接受手术的患者与三天后接受手术的患者在复视和眼外肌（EOM）运动恢复率方面没有显著差异。然而，在手术间隔超过三天的患者中，肌肉嵌顿的患者比软组织嵌顿的患者从EOM运动受限中恢复所需的时间更长（P = 0.03），复视恢复所需时间也更长（P = 0.03）。无论手术间隔时间如何，与软组织嵌顿的患者相比，肌肉嵌顿的患者从EOM运动受限中恢复所需的时间更长（P = 0.036），复视恢复所需时间更长（P = 0.042），且EOM恢复率有更差的趋势。因此，我们建议对于伴有直肌嵌顿的眶壁陷窝骨折应及时处理，以促进更快恢复。
