CAJ | 학술논문

目的探讨应用三维眶底重建钛网治疗复合性眼眶骨折修复眶底缺损的手术方法和临床效果.方法回顾性系列病例研究.回顾性分析13例(13只眼)行三维眶底重建钛网植入眼眶骨折修复眶底重建手术的复合性眼眶骨折患者的临床资料.其中眶颧颌骨折6例,鼻眶筛骨折5例,眼眶四壁多发性骨折2例.术中联合行颧骨、上颌骨骨折、鼻骨以及额骨骨折修复,8例眼球重度凹陷的患者同时行高密度聚乙烯眶内充填.手术前后测量眼球突出度、眼球运动以及眼眶CT扫描(水平位、冠状位以及三维重建).术后随访3～6个月.结果术前患眼眼球凹陷平均(3.9±1.7)mm,眼球下移(3.1±2.6)mm.13例患者中,12例存在眼球运动障碍,其中Ⅰ级有4例,Ⅱ级有7例,Ⅲ级有2例.术后除3例患者残存眼球凹陷1.0 mm,其余10例患者眼球凹陷矫正;8例患者眼球下移完全矫正,3例残留眼球下移1.0 mm,2例患者眼球上移1.0 mm;术后3个月后8例患者眼球运动受限完全矫正,其余5例眼球运动障碍减轻,其中残留Ⅱ级运动障碍2例,Ⅰ级运动障碍3例;随访过程中未发现三维眶底重建钛网移位、排斥、感染及其他不良反应.结论三维眶底重建钛网具有良好的生物相容性,采用三维眶底重建钛网治疗复合性眼眶骨折,可有效恢复眼眶容积,矫正眼球内陷和下移,改善眼球运动.
목적 탐토응용삼유광저중건태망치료복합성안광골절수복광저결손적수술방법화림상효과.방법 회고성계렬병례연구.회고성분석13례(13지안)행삼유광저중건태망식입안광골절수복광저중건수술적복합성안광골절환자적림상자료.기중광권합골절6례,비광사골절5례,안광사벽다발성골절2례.술중연합행권골、상합골골절、비골이급액골골절수복,8례안구중도요함적환자동시행고밀도취을희광내충전.수술전후측량안구돌출도、안구운동이급안광CT소묘(수평위、관상위이급삼유중건).술후수방3～6개월.결과 술전환안안구요함평균(3.9±1.7)mm,안구하이(3.1±2.6)mm.13례환자중,12례존재안구운동장애,기중Ⅰ급유4례,Ⅱ급유7례,Ⅲ급유2례.술후제3례환자잔존안구요함1.0 mm,기여10례환자안구요함교정;8례환자안구하이완전교정,3례잔류안구하이1.0 mm,2례환자안구상이1.0 mm;술후3개월후8례환자안구운동수한완전교정,기여5례안구운동장애감경,기중잔류Ⅱ급운동장애2례,Ⅰ급운동장애3례;수방과정중미발현삼유광저중건태망이위、배척、감염급기타불량반응.결론 삼유광저중건태망구유량호적생물상용성,채용삼유광저중건태망치료복합성안광골절,가유효회복안광용적,교정안구내함화하이,개선안구운동.
Objective To evaluate the outcomes of the clinical application of three-dimensionally preformed titanium mesh plates for posttraumatic complex orbital bone fracture reconstruction. Methods Thirteen patients (13 eyes) manifested with complex orbital fractures (including orbital-zygomatic- maxillary bone fracture in 6 patients,nasal-orbital-ethmoid bone fracture in 5 patients and complex multiple periorbital bone fracture in other 2 patients ) underwent the reconstructive surgery by using three-dimensionally preformed titanium mesh plates. Eight cases underwent high density porous polyethylene implantation simultaneously. Evaluation of enophthalmos,eyeball movement,and orbit CT scan were taken pre- and post-operatively. Results The average enophthalmos was (3.9 ± 1.7 ) mm and the position of the affected eyeball was( 3. 1 ± 2. 6)mm bellow the contralateral side preoperatively. Twelve patients suffered from eyeball movement restriction,including grade Ⅰ in 4 cases,grade Ⅱ in 7 cases and grade Ⅲ in 2 cases. During the 3 to 6 months post operative follow-up,enophthalmos was completely corrected in 10 patients while the other 3 patients had residual 1.0 mm enophthalmos. The affected eyeballs were repositioned in 8 cases and 3 cases had residual 1 mm lower position and 2 cases with a 1 mm higher positioned eyeball. Eye movement was not restricted in 8 patients,whereas 3 patients had grade Ⅰ movement restriction and 2 patients had grade Ⅱ movement restriction. There were no rejection,infection and other complications during follow-up.Conclusions Three-dimensionally preformed titanium mesh plates can be used to reconstruct posttraumatic complex orbital bone fractures in order to improve the orbital volume and to correct enophthalmos effectively.