计算机辅助导航系统和个体化三维钛网在陈旧性眶颧骨折治疗中的应用

Application of navigation and individual designed titanium mesh in the treatment of delayed orbitozygomatic fractures with enophthalmos

目的:研究计算机辅助导航系统结合个体化三维钛网在复合性眼眶骨折治疗中的应用,并与传统手术方法进行比较,评价其治疗效果。方法:2008年10月-2010年12月在上海交通大学医学院附属第九人民医院口腔颌面外科和眼科联合治疗的陈旧性单侧眶颧骨折伴眼球内陷畸形病例64例,其中25例采用计算机辅助手术治疗以提高颧骨复位的准确性,术前眼球内陷平均5.71mm;39例采用传统方法治疗,术前眼球内陷平均4.96mm。眶重建中,35例采用钛网,12例采用聚乙烯聚合物(Medpor),5例采用羟基磷灰石板(HA),12例采用钛网+Medpor或HA。手术前后进行眼眶CT扫描、冠状和三维骨重建,术后评价颧骨复位和眼球内陷矫正效果。结果:计算机辅助治疗术后颧骨复位的满意率为92%,眼球突度满意率(≤2mm)为82%,轻度眼球内陷率(≤3mm)为17%。传统手术颧骨复位满意率为74%,眼球突度满意率为74%,轻度眼球内陷率(≤3mm)为19%,中度眼球内陷率(≤4mm)为6%。眼球突度满意率,单纯使用钛网为74%,联合材料为83%,Medpor为67%,HA为20%。结论:计算机辅助手术可提高陈旧性眶颧骨折伴眼球内陷畸形的治疗效果;钛网联合Medpor是治疗严重眼球内陷畸形的良好方法。

PURPOSE： To evaluate the usefulness of computer-assisted surgery（navigation and stereolithographic model guided surgery） and compare the results with traditional surgery on the treatment of delayed orbitozygomatic fracture with enophthalmos.METHODS： Sixty-four patients diagnosed as delayed unilateral orbito-zygomatic fractures with enophthalmos were treated in the Department of Oral and Maxillofacial Surgery and Department of Ophthalmology in Shanghai Ninth People＇s Hospital from October,2008 to December,2010.Among them,25 cases were treated by computer-assisted surgery with the mean enophthalmos of 5.71mm,the other 39 were treated traditionally with the mean enophthalmos of 4.96mm.Materials used for orbital reconstruction were： titanium mesh（n=35）;titanium mesh combined with porous polyethylene（Medpor） or hydroxyapatite（HA）（n=12）;Medpor（n=12） and HA（n=5）.CT scan before and after surgery were acquired with orbital coronal reconstruction and three-dimensional bone reconstruction.Zygomatic reduction and globe projection of different treatment methods were evaluated by post-operative CT scan and clinical follow-up.RESULTS： In computer-assisted surgery,good zygomatic reduction was acquired in 92% of the cases;globe projection was good in 82% of the cases,17% still had mild enophthalmos（≤3mm）.In traditional treated cases,good zygomatic reduction was acquired in 74.3% of the cases;globe projection was good in 74% of the cases,19% still had mild enophthalmos and 6% had moderate enophthalmos（≤4mm）.Good globe projection was acquired in 74% of the cases with titanium mesh only;83% with combined materials;67% with Medpor and 20% with HA.CONCLUSION： Computer-assisted surgery can improve the treatment results of delayed orbitozygomatic fracture with enophthalmos.Titanium mesh with Medpor for orbital reconstruction is a good way to treat severe enophthalmos.Supported by the Cooperated Foundation of Medical and Engineering Science of Shanghai Jiao Tong University（40YG2009ZD102）,and Pujiang Talent Program of Shanghai Municipality[PJ（2009）00840].