1例眼眶爆裂性骨折患者的循證治療_《中國循證醫學雜志》

作者：

葛軼睿 , 石堯 , 蔣峰 , 丁莉莉 ,  黃振平

南京軍區南京總醫院眼科（南京 210002）;

關鍵詞：

眼眶爆裂性骨折手術適應癥手術時機循證治療

DOI：

10.7507/1672-2531.20100388

視頻：

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目的　針對一例眼眶爆裂性骨折患者，檢索當前最佳證據，為臨床治療提供參考。
方法　針對提出的臨床問題，全面檢索Cochrane 圖書館網絡版（2009 年第1 期）、ACP online、NGC（1998 ～ 2009 年3 月）、PubMed（1950年1 月～ 2009 年2 月）及CBM（1994 ～ 2009 年2 月），獲取與兒童眼眶爆裂性骨折手術適應癥、手術時機及眼眶植入物相關的系統評價及臨床隨機對照試驗，如無高級別證據，則逐級降低證據等級以獲得相關文獻。
結果　最終納入12 篇文獻，多為回顧性分析或專家意見。眼眶爆裂性骨折的手術適應癥包括眶內物的嵌頓、眼球運動受限、復視、眼球退縮及臨床不能自行緩解的眼心反射；尤其是兒童患者出現眶內物嵌頓，為顯著手術指征。眼眶爆裂性骨折手術時機無明確定論，大多數文獻認為兒童宜在5 天內手術，成人半月內手術，但對于早期無法及時手術者，晚期手術仍是可選擇的方式。鈦網及聚對二氧環已酮（PDS）兩種眼眶植入物，后者優于前者。
結論　眼眶爆裂性骨折循證證據級別較低，應用須慎重，個體治療應緊密結合臨床。

引用本文： 葛軼睿,石堯,蔣峰,丁莉莉,黃振平. 1例眼眶爆裂性骨折患者的循證治療. 中國循證醫學雜志, 2010, 10(2): 220-222. doi: 10.7507/1672-2531.20100388 復制

1.	Levels of Evidence. Available From: URL:http://www.cebm.net/index. aspx?o=1025. [2009-03-26].
2.	Adeyemo WL, Aribaba OT, Ladehinde AL, et al. Mechanisms of orbital blowout fracture: a critical review of the literature. Niger Postgrad Med J, 2008, 15(4): 251-254.
3.	Parbhu KC, Galler KE, Li C, et al. Mawn LA. Underestimation of soft tissue entrapment by computed tomography in orbital floor fractures in the pediatric population. Ophthalmology, 2008, 115(9): 1620-1625.
4.	Losee JE, Afifi A, Jiang S, et al. Pediatric orbital fractures: classification, management, and early follow-up. Plast Reconstr Surg, 2008, 122(3): 886-897.
5.	Theologie-Lygidakis N, Iatrou I, Alexandridis C. Blow-out fractures in children: six years’ experience. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2007, 103(6): 757-763.
6.	Eye. American College of Occupational and Environmental Medicine- Medical Specialty Society. 2004. 77 pages. NGC: 004759.
7.	HakeliusL, PontenB. Results of immediate and delayed surgical treatment of fractures with diplopia. J Maxillofac Surg, 1973, 1(3): 150-154.
8.	Kwon JH, Moon JH, Kwon MS, et al. The differences of blowout fracture of the inferior orbital wall between children and adults. Arch Otolaryngol Head Neck Surg, 2005, 131(8): 723-727.
9.	宋維賢, 孫華. 兒童眶壁爆裂性骨折的臨床分析. 眼科, 2005, 14(6): 380-382.
10.	Dal Canto AJ, Linberg JV. Comparison of orbital fracture repair performed within 14 days versus 15 to 29days after trauma. Ophthal Plast Reconstr Surg, 2008, 24(6): 437-443.
11.	肖利華. 眼眶爆裂性骨折手術治療時應注意的幾個問題. 眼科, 2006, 15(6): 361-362.
12.	范先群. 眼眶骨折整復手術的現狀和問題. 眼科, 2005, 14(6): 357-359.
13.	范先群, 張滌生, 馮勝之, 等. 眼眶爆裂性骨折眼球內陷的晚期整復治療. 中華眼科雜志, 2002, 38(11): 644-646.
14.	Converse JM, Smith B. Reconstruction of the floor of the orbit by bone grafts. Arch Ophthal, 1950, 44(1): 1-21.
15.	Dacho A, Steffen H, Ziegler CM, et al. Comparison of a new perforated 0.15 mm thick PDS layer with established titanium dynamic mesh. HNO, 2002, 50(1): 21-28.
16.	Ziegler CM, Dacho A, Althof F, et al. Effectiveness of a new perforated 0.15 mm poly-p-dioxanon-foil versus titanium-dynamic mesh in reconstruction of the orbital floor. J Craniomaxillofac Surg, 2001, 29(2): 82-88.

1. Levels of Evidence. Available From: URL:http://www.cebm.net/index. aspx?o=1025. [2009-03-26].
2. Adeyemo WL, Aribaba OT, Ladehinde AL, et al. Mechanisms of orbital blowout fracture: a critical review of the literature. Niger Postgrad Med J, 2008, 15(4): 251-254.
3. Parbhu KC, Galler KE, Li C, et al. Mawn LA. Underestimation of soft tissue entrapment by computed tomography in orbital floor fractures in the pediatric population. Ophthalmology, 2008, 115(9): 1620-1625.
4. Losee JE, Afifi A, Jiang S, et al. Pediatric orbital fractures: classification, management, and early follow-up. Plast Reconstr Surg, 2008, 122(3): 886-897.
5. Theologie-Lygidakis N, Iatrou I, Alexandridis C. Blow-out fractures in children: six years’ experience. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2007, 103(6): 757-763.
6. Eye. American College of Occupational and Environmental Medicine- Medical Specialty Society. 2004. 77 pages. NGC: 004759.
7. HakeliusL, PontenB. Results of immediate and delayed surgical treatment of fractures with diplopia. J Maxillofac Surg, 1973, 1(3): 150-154.
8. Kwon JH, Moon JH, Kwon MS, et al. The differences of blowout fracture of the inferior orbital wall between children and adults. Arch Otolaryngol Head Neck Surg, 2005, 131(8): 723-727.
9. 宋維賢, 孫華. 兒童眶壁爆裂性骨折的臨床分析. 眼科, 2005, 14(6): 380-382.
10. Dal Canto AJ, Linberg JV. Comparison of orbital fracture repair performed within 14 days versus 15 to 29days after trauma. Ophthal Plast Reconstr Surg, 2008, 24(6): 437-443.
11. 肖利華. 眼眶爆裂性骨折手術治療時應注意的幾個問題. 眼科, 2006, 15(6): 361-362.
12. 范先群. 眼眶骨折整復手術的現狀和問題. 眼科, 2005, 14(6): 357-359.
13. 范先群, 張滌生, 馮勝之, 等. 眼眶爆裂性骨折眼球內陷的晚期整復治療. 中華眼科雜志, 2002, 38(11): 644-646.
14. Converse JM, Smith B. Reconstruction of the floor of the orbit by bone grafts. Arch Ophthal, 1950, 44(1): 1-21.
15. Dacho A, Steffen H, Ziegler CM, et al. Comparison of a new perforated 0.15 mm thick PDS layer with established titanium dynamic mesh. HNO, 2002, 50(1): 21-28.
16. Ziegler CM, Dacho A, Althof F, et al. Effectiveness of a new perforated 0.15 mm poly-p-dioxanon-foil versus titanium-dynamic mesh in reconstruction of the orbital floor. J Craniomaxillofac Surg, 2001, 29(2): 82-88.

《中國循證醫學雜志》

1例眼眶爆裂性骨折患者的循證治療

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《中國循證醫學雜志》

1例眼眶爆裂性骨折患者的循證治療

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