计算机辅助预成形钛网整体修复复合性眼眶骨折应用分析

Clinical study of computer-assisted prefabricated titanium mesh for reconstruction of complex orbital fracture

目的探讨计算机辅助预成形钛网在眼眶复合性骨折整体修复中的安全性和有效性。方法复合性眼眶骨折患者15例15只眼，分成两组：A组：5例患者术中应用眶缘型HA复合材料修复眶缘，板状HA复合材料修复眶壁。B组：10例患者术中植入计算机辅助设计预成形钛网，同时修复眶壁及眶缘，行眼眶整体修复。术后2周、3个月、6个月复查，观察两组眼球突出度、眶容积、复视改善情况，评价计算机辅助设计制作钛网修复复合性眼眶骨折的治疗效果。结果术后眼球内陷矫正率：2周：A组60％，B组80％；3个月和6个月基本相同：A组40％，B组70％；术后眶容积扩大量明显缩小，A组平均缩小3．1ml，B组缩小3．7ml；复视矫正情况：2周治愈率：A组：20％，B组：50％，3个月：A组40％，B组：60％，6个月：A组40％，B组：70％。术后无视力下降，未发生植入材料移位、排异、感染等并发症。结论应用计算机辅助预成形钛网整体修复眼眶复合性骨折可以更加精确的修复眼眶，提高眼球内陷和复视的治愈率。

Objective To explore the safety and efficacy of computer-assisted prefabricated titanium mesh for overall repairing orbital wall and rim in complex orbital fracture patients. Methods Fifteen patients were included in this study. All patients suffered from complex orbital fracture. Group A included 5 patients who were reconstructed for the complex fractured orbital wall and rim with Hydroxyapatite. Group B had 10 patients treated with computer-assisted fabricated titanium mesh. The efficacy of computer-assisted prefabricated titanium mesh for complex orbital fracture was evaluated by postoperative measurements of diplopic figures, exophthalmos and changes of orbital ca- pacity obtained by CT on postoperative week 2 and month 3, and 6. Results The cure rate of En- ophthalmos after operation： 2 weeks： group A was 60%, group B was 80%, and the cure rate both the same in 3 months and 6 months after operation： group A was 40%, group B was 70%. The en- largement volume of orbit in Postoperative was deereaged. The mean value of group A was 3.1 ml. Group B was 3.7ml. The cure rate of diplopia： 2 weeks cure rate： group A： 20%, group B： 50%, 3 months： 40% of group A, group B： 60%, 6 months： 40% of group A, group B： 70%. There was no vision loss, graft extrusion, rejection, infection and other complications in all patients after operation. Conclusions Computer-assisted prefabricated titanium mesh introduced into the overall plastic surgery of complex orbital fracture can provide more accurate orbital reconstruction and improve the correction of enophthalmia and diplopia.