预塑形钛网植入对眼眶骨折手术治疗预后的影响

Effect of pre-shaped titanium mesh implantation on the prognosis of patients with orbital fractures

目的:探讨与常规钛网手术植入相较,3D打印的预塑形钛网在眼眶骨折修复中的有效性和安全性。方法:选择2015-06/2016-03来我院眼科就诊的眼眶骨折患者72例72眼进行回顾性分析。全部病例分为两组,其中预塑形钛网植入组(观察组)40例40眼,常规钛网植入组(对照组)32例32眼。对照组由医师根据经验手工弯制和塑形衬垫钛网植入患侧眼眶;观察组由医师直接在患侧眼眶植入3D打印的预塑形钛网。在术后1、3、6mo复查眼球内陷、复视、眼球运动恢复情况,比较两种方法各观察指标在手术前后不同时间点的组内差异,及同一时间点两种材料间各指标的组间差异。结果:观察组和对照组眼球内陷治愈率分别为84%、59%,两组相比,差异有统计学意义(P<0.05);观察组和对照组复视治愈率分别为80%和70%,两组相比差异无统计学意义(P>0.05);观察组眼球运动受限治愈率为73%,对照组治愈率为66%,两组相比,无显著统计学意义(P>0.05)。术后随访期间两组均无感染,无钛网移位、脱出、变形及排斥等并发症。结论:预塑形钛网植入眼眶骨折患者手术术中无需塑形,可缩短手术时间,重建眶壁确切,减少手术并发症,提高疗效。

AIM：To study the effectiveness and safety of 3D printing pre-shaped titanium mesh in the repair of orbital fracture compared with the conventional titanium mesh.METHODS：The clinical data of 72 eyes of 72 patients who received surgery for orbital fracture from June 2015 to March 2016 in our department were retrospectively analyzed.All patients were divided into two groups,including pre-shaped titanium mesh implantation group（observation group）,40 cases,conventional titanium mesh implantation group（control group）,32 cases.The control group was treated by physicians according to the experience of manual bending and shaping titanium mesh implantation ipsilateral orbital pad,when the observation group by the physicians directly in the pre-shaped titanium mesh of 3D printing.The eyeball exophthalmos,eye movement and diplopia were evaluated in the next 1,3 and 6mo after the operation,and we compared the differences between the two methods at different time points and the differences of the indexes between the two materials at the same time point.RESULTS：The cure rate of the observation group and the control group about eyeball exophthalmos values was 84%and 59%,the difference of the two groups was statistically significant（P0.05）.The cure rates of diplopia of the two groups were 80%and 70%without significant difference（P0.05）.The cure rate of limited ocular movement of observation group was 73%,that of control group was 66%,there was no statistical significance（P0.05）.During the follow-up period,there was no infection in the two groups,no titanium mesh shift,extrusion,deformation and rejection or other complications.CONCLUSION：Pre-shaped titanium mesh shaping orbital implantation with no need for shaping the mesh in the operation,can shorten the operation time,make accurate reconstruction of orbital wall,reduce complications and improve the curative effect.