钛板与羟基磷灰石复合人工骨在眼眶重建中的应用研究

Orbital reconstruction with titanium and polyethylene coated by coral hydroxyapatite

目的探讨应用钛板、羟基磷灰石复合人工骨矫正眼眶骨折的手术方法和疗效。方法根据术前CT诊断明确的25例(25眼)眼眶骨折术中用钛钉、钛板将复位的眶缘骨折进行坚强内固定,重建正常的眶缘,用羟基磷灰石人工骨材料植入眼眶,以填补眶腔容积的缺损,同时修复重建眶壁。结果术后随访3～12月,CT水平和冠状位扫描复查,眼球内陷的18眼中,17眼获得矫正,1眼仍存在中度内陷,再次手术后矫正。复视5例中,4例获得良好改善,1例无效,偶伴歪头。3例颧弓骨折,与口腔科联合手术后完全矫正。无植入物感染、移位和脱出,未见视力丧失者。结论钛板和复合羟基磷灰石人工骨具有很好的生物相容性,在眶壁重建手术中可获得满意的疗效,是眶壁重建术良好的替代材料。

Objective To investigate the technique of reconstruction and repair of complex posttraumatic enophthalmos with miniplate of titanium and porous high density polyethylene coated by coral hydroxyapatite, and evaluate its efficacy. Methods According to the computed tomography （CT） examination, the displaced orbital bone rims were repositioned and rigid fixed by mini-plates and screws and the orbital wall were then repaired and the loss of the orbital volume were filled with polyethylene coated by coral hydroxyapatite （CHA） material. Results 25 cases in the hospitals were reviewed. In the 18 cases with enophthalmos, 17 cases presented moderate enophthalmos （3 - 4mm） and 1 cases presented severe enophthalmos（5- 6mm）. After follow - up for three to twelve months, 17 cases had no enophthalmos （≤ 2mm）, 1 cases had moderate enophthalmos, four of 5 cases had diplopia preoperatively. 4 cases had satisfactory result, and 1 case had no change. 3 cases with fracture in cheek bone were finished with stomatologist. There was no infection, migration and extrusion of the implants. There was no visual loss. Conclusions The reconstruction of orbital walls and reposition of enophthalmos with mini-plate titanium and polyethylene coated by CHA had satisfactory results. Polyethylene coated by CHA is a useful orbital implant material.