外伤性眶底骨缺损的重建

Clinical study on reconstruction of traumatic bony defects of orbital floor

目的介绍重建外伤性眶底骨缺损的方法与疗效。方法在眶周骨折复位同期,对24例眶底骨缺损经下睑缘下途径重建,使用微型钛板重建12例,钛网6例,自体骨6例(上颌窦壁3例、喙突1例、髂骨2例)。结果全部患者颧部塌陷与眼球外观畸形矫正满意,下睑缘切口瘢痕不明显。术前15例眼与眶下神经功能障碍者中,术后半年仅1例复视、2例眶下神经麻痹未消失,均为伤后6～8周后期治疗者。影像检查植入物位置理想。结论早期重建眶底骨缺损有利于功能恢复,减少并发症。重建材料应根据骨缺损程度与眼球位置选择,缺损范围较小且眼球位置正常者可使用微型钛板、钛网重建,反之应使用自体骨重建以缩小眶腔容积并支撑眼球。

Objective To introduce the clinical application of several materials for reconstructing traumatic bony defects of orbital floor. Methods Reconstruction of bony defects of orbital floor were completed via inferior palpebral margin approach simultaneously in fixing maxillofacial fractures for 24 cases. Materials used for reconstruction of bony defects included micro Ti-plate(12), Ti-mesh(6) and autogenous bone( wall of maxillar sinus 3, coronoid process 1 and iliac bone 2). Results Facial asymmetries were corrected satisfactorily and incisal scars of lower eyelid were not seen obviously in all patients. Of 15 cases in which ophthalmic and feeling nervous dysfunctions existed preoperatively, diplopia and inferior orbital nerve palsy were present only in 1and 2 cases separately half a year post-operation who accepted operations 6-8 weeks after injury. All grafts were observed in ideal sites of orbital floor by X-ray films and spiral CT scanning. Conclusions Early reconstruction of traumatic bony defects of orbital floor can harvest the most benefits from recovering eye function and decreasing post-traumatic complications. Materials for reconstructing should be chosen according to the size of bony defects and the position of eyeball. Using micro Ti-plate or Ti-mesh is an effective and convenient way in the situation that the diameter of defect is not bigger than 1 cm and the position of eyeball is not shifted. On the contrary, autogenous bony grafts should be used to reduce the volume of the orbital cavity and support eyeball.