眼眶骨折眼窝凹陷的手术治疗

Surgical Treatment of Enophthalmic Eye Socket and Orbital Fracture

目的:探讨采用高密度多聚乙烯(Medpor)眼眶重建联合多孔羟基磷灰石(HA)眼座植入治疗眼眶骨折眼窝凹陷的临床效果及安全性。方法:以Medpor眼眶填充联合HA眼座眶内植入治疗合并有眼眶骨折的眼窝凹陷27例。Medpor为孔径100μ的内联多孔板块状材料,分为眶底和眶缘两类。HA为孔径500μ的进口天然珊瑚羟基磷灰石。术中先行HA眼座一期或二期植入,后根据眼眶骨缺损以填充修补。结果:27例患者均获满意效果,随访6.5月可见双侧眼眶基本对称,上眶区饱满无凹陷,佩戴义眼片后患眼眼球突出度与健眼相近,患侧眶缘连续,外形良好,眶周无植入体轮廓阴影或阶梯状畸形。Medpor植入前后对眼座活动度无显著性影响。未见植入物脱出、感染、移位等并发症。结论:Medpor是一种良好的骨替代材料,具有组织相容 性好、易塑形、可血管化等诸多优点。明显优于自体组织及其他人工材料,以Medpor眼眶填充联合HA眼座眶内植入术治疗合并有眼眶骨折的眼窝凹陷为一良好术式。

Objective: To evaluate the clinical effect and safety of orbital socket reconstruction by prosthesis implantation using Hydroxyapatite (HA) combine with Medpor for the treatment of enophthalimc eye socket and orbital fracture. Methods: 27 cases with enophthalmic eye socket and orbital fracture had been treated with socket reconstruction by prosthesis implantation using Hydroxyapatite (HA) combine with Medpor. HA was a kind of plate like material with inner-connected multiple holes and the diameter of 100μm, it was divided into two types: orbital rim and orbital bottom. HA was a kind of nature material of coral Hydroxyapat it with the diameter of 500μm. After primary or secondary HA prosthesis implantation, Medpor reconstruction have been done according to the defection of the orbit bone. Results: All of the 27 cases were followed up for 6 to 10 months (mean 6.5m), the result was satisfied. Both sides of the orbit were symmetric. Superior orbit was full and no depression. The enophthalmic degree of the implants was also symmetric with the other eye. The orbital rims of the affected eye were continuous and in good shape, no shadow and ladder like deformation of the implants around the orbit, no implants prolapse, infection, dislocation and other complications. During the implantation of Medpor, there was no significant effect to the motility of HA. Conclusion: Medpor should be a good material for substitution of the bone, it had good tissue compatability, easy for shape and vascularization and was much more better than autogenous tissue and other artificial material. Orbital socket reconstruction by prosthesis implantation using Hydroxyapatite (HA) combine with Medpor for the treatment of enophthalmic eye socket and orbital fracture might be a good and useful way.