Effect of navigation endoscopy combined with threedimensional printing technology in the treatment of orbital blowout fractures

●AIM:To explore the combined application of surgical navigation nasal endoscopy(NNE)and three-dimensional printing technology(3DPT)for the adjunctive treatment of orbital blowout fractures(OBF).●METHODS:Retrospective analysis was conducted on the data of patients with OBF who underwent surgical treatment at the Affiliated Eye Hospital of Nanchang University between July 2012 and November 2022.The control group consisted of patients who received traditional surgical treatment(n=43),while the new surgical group(n=52)consisted of patients who received NNE with 3DPT.The difference in therapeutic effects between the two groups was evaluated by comparing the duration of the operation,best corrected visual acuity(BCVA),enophthalmos difference,recovery rate of eye movement disorder,recovery rate of diplopia,and incidence of postoperative complications.●RESULTS:The study included 95 cases(95 eyes),with 63 men and 32 women.The patients’age ranged from 5 to 67y(35.21±15.75y).The new surgical group and the control group exhibited no statistically significant differences in the duration of the operation,BCVA and enophthalmos difference.The recovery rates of diplopia in the new surgical group were significantly higher than those in the control group at 1mo[OR=0.03,95%CI(0.01–0.15),P<0.0000]and 3mo[OR=0.11,95%CI(0.03–0.36),P<0.0000]postoperation.Additionally,the recovery rates of eye movement disorders at 1 and 3mo after surgery were OR=0.08,95%CI(0.03–0.24),P<0.0000;and OR=0.01,95%CI(0.00–0.18),P<0.0000.The incidence of postoperative complications was lower in the new surgical group compared to the control group[OR=4.86,95%CI(0.95–24.78),P<0.05].●CONCLUSION:The combination of NNE and 3DPT can shorten the recovery time of diplopia and eye movement disorder in patients with OBF.

Biomechanical analysis of an absorbable material for treating fractures of the inferior orbital wall

AIM:To investigate the biomechanical properties and practical application of absorbable materials in orbital fracture repair.METHODS:The three-dimensional(3D)model of orbital blowout fractures was reconstructed using Mimics21.0 software.The repair guide plate model for inferior orbital wall fracture was designed using 3-matic13.0 and Geomagic wrap 21.0 software.The finite element model of orbital blowout fracture and absorbable repair plate was established using 3-matic13.0 and ANSYS Workbench 21.0 software.The mechanical response of absorbable plates,with thicknesses of 0.6 and 1.2 mm,was modeled after their placement in the orbit.Two patients with inferior orbital wall fractures volunteered to receive single-layer and double-layer absorbable plates combined with 3D printing technology to facilitate surgical treatment of orbital wall fractures.RESULTS:The finite element models of orbital blowout fracture and absorbable plate were successfully established.Finite element analysis(FEA)showed that when the Young’s modulus of the absorbable plate decreases to 3.15 MPa,the repair material with a thickness of 0.6 mm was influenced by the gravitational forces of the orbital contents,resulting in a maximum total deformation of approximately 3.3 mm.Conversely,when the absorbable plate was 1.2 mm thick,the overall maximum total deformation was around 0.4 mm.The half-year follow-up results of the clinical cases confirmed that the absorbable plate with a thickness of 1.2 mm had smaller maximum total deformation and better clinical efficacy.CONCLUSION:The biomechanical analysis observations in this study are largely consistent with the clinical situation.The use of double-layer absorbable plates in conjunction with 3D printing technology is recommended to support surgical treatment of infraorbital wall blowout fractures.

Analysis of the effect of repair materials for orbital blowout fracture on complications

AIM: To investigate the effect of repair materials for orbital blowout fractures on the occurrence of postoperative complications. METHODS: The clinical data and follow-up data of 54 subjects with orbital blowout fractures were retrospectively analyzed. The study was divided into three groups according to the used repair materials: titanium mesh(16 cases), Medpor(12 cases), and Medpor titanium mesh(26 cases). All test data were analyzed using the SPSS version 23.0 statistical software. The mean age and duration of disease between the groups were compared through oneway analysis of variance. The Chi-square(χ~2) test was used to compare the number of males and females, different fracture types, and different surgical approaches among groups. The χ~2 test was used to compare the frequencies for complications in each group.RESULTS: The baseline characteristics of age and gender in each group were matched(F=1.763, P=0.172;χ~2=0.026, P=0.987). In addition, there was no difference in the type of fracture and surgical approach(χ~2=0.460, P=0.977;χ~2=0.691, P=0.952), or the incidence of complications(χ~2=0.081, P=0.960) between the three groups. CONCLUSION: Although there is no difference in effect of various repair materials on the incidence of complications, the effect of repair materials on postoperative complications of orbital blowout fractures should not be ignored.

Role of orthoptics and scoring system for orbital floor blowout fracture:surgical or conservative treatment

AIM:To assess the role of orthoptics in referring patients with orbital floor blowout fracture(OFBF)for conservative or surgical treatment and based on the results,to propose a scoring system for such decision making.METHODS:A retrospective analysis of 69 patients with OFBF was performed(35 treated conservatively,34 surgically).The role of orthoptics in referring to surgery or conservative treatment was retrospectively evaluated,the factors with the highest significance for decision making were identified,and a scoring system proposed using Logistic regression.RESULTS:According to defined criteria,the treatment was unsuccessful in 2(6%)surgically treated and only in one(3%)conservatively treated patient.The proposed scoring system includes the defect size and several values resulting from the orthoptic examination,the elevation of the eyebulb measured on Lancaster screen being the most significant.CONCLUSION:The study demonstrates the benefits of orthoptic examination when making decisions on conservative or surgical treatment and for diagnosing ocular motility disorder(with or without binocular diplopia)in OFBF patients.The proposed scoring system could,following verification in a prospective study,become a valuable adjunctive tool.

四川盆地二叠系茅口组海相缝洞型气藏试气关键技术

四川盆地二叠系茅口组过平衡钻井液渗滤污染严重,对深穿透射孔、酸压工艺、压井堵漏等试气施工关键技术提出了更高要求。通过对射孔枪弹、射孔液、射孔引爆方式进行优化,同时,通过全岩矿物溶蚀实验、排量预测研究,优化了酸压工艺、堵漏浆配方及压井堵漏方法,形成了超深穿透射孔、酸压、压井堵漏等系列关键工艺技术,满足了缝洞体储层试气技术需求。现场应用6口井/8层,均获得了工业气流,单层试气周期平均缩短9 d,实现了四川盆地二叠系海相碳酸盐岩茅口组气藏“1”字号井的勘探突破。该技术为同类型储层试气施工提供了技术参考。

信息化多元康复护理对腰椎爆裂性骨折术后功能恢复的影响

目的探讨信息化多元康复护理对腰椎爆裂性骨折术后功能恢复的影响。方法选取2021年2月至2022年2月在抚州第五医院诊治的106例腰椎爆裂性骨折患者为研究对象,根据简单数字表法将其分为对照组和观察组,每组各53例。两组患者均接受手术治疗,对照组患者术后给予常规康复护理干预,观察组患者术后给予信息化多元康复护理干预,两组均连续干预3个月。比较两组患者的术后康复指标、干预前后视觉模拟评分法(visual analogue scale,VAS)评分、日本骨科协会评估治疗评分(Japanese Orthopedic Association scores,JOA评分)、生活质量、并发症发生情况。结果观察组患者的首次进食时间、首次排气时间、导尿管留置时间、首次下床活动时间、住院时间均显著短于对照组(P<0.05)。干预后2周~3个月,两组患者的VAS评分均呈下降趋势,JOA评分均呈升高趋势,且观察组患者各时间点的VAS评分均显著低于对照组,JOA评分均显著高于对照组(P<0.05)。干预后,两组患者的健康调查量表36(36-item short form health survey,SF-36)各项评分均显著高于本组干预前,且观察组患者的SF-36各项评分均显著高于对照组(P<0.05)。观察组患者的并发症总发生率显著低于对照组(χ^(2)=3.944,P=0.047)。结论腰椎爆裂性骨折患者应用信息化多元康复护理可有效缓解疼痛,改善腰椎脊柱功能,预防并发症发生,从而提高生活质量。

眼眶壁爆裂性骨折56例的修复治疗

目的 探讨眼眶壁爆裂性骨折手术治疗的方法和效果。方法 眼眶壁爆裂性骨折56例,采用眼眶骨膜下垫压填充术修复治疗,并总结分析其疗效。结果 47例有眼球运动障碍的患者中,42例恢复正常,5例仍有不同程度的复视。19例并发眼球内陷者中,14例得到充分矫正,5例较术前有明显改善。随访中未发现垫入物排斥现象。结论 对于伴有复视、眼球运动障碍的眼眶壁爆裂性骨折应尽早手术治疗。当双眼突出度相差大于3mm,即应手术矫正,且当眶脂肪萎缩时应增加垫压物,手术关键应在骨膜下进行,以避免并发症。骨水泥和Medpor使用起来安全,效果肯定。

Medpor在眼眶爆裂性骨折整复中的应用

目的:探讨Medpor在眼眶爆裂性骨折中的疗效。方法:患者21例,采用手术切开复位,Medpor填充。结果:所有患眼眼球内陷均得以矫正,双眼突出度基本一致,眼球各方向运动基本到位。19例复视消失,1例复视改善但仍存在,1例复视无改善。结论:Medpor在眼眶爆裂性骨折整复中是一种安全有效的填充材料。

眼眶骨折168例临床分析

目的通过分析眼眶骨折患者的临床资料,探讨其致伤原因、临床特点及治疗方法。方法 对2012年6月至2013年6月确诊眼眶骨折住院治疗的患者168例（180眼）进行回顾性分析。结果 168例180眼患者中爆裂骨折137眼（含多壁复合骨折8眼）、直接骨折17眼、合并眶颧颌复合体骨折26眼。168例180眼患者中保守治疗88例（98眼）、手术治疗80例（82眼）;手术指征：眼球内陷35例（35眼）,复视及眼球运动受限24例（24眼）,内陷合并复视19例（21眼）,内陷合并严重眼球破裂伤2例（2眼）,眶颧颌复合体患者尚合并颜面畸形和（或）张口困难等功能障碍。手术时机：伤后3～21d,平均10.57d。随访3个月,所有患者眼球内陷、复视、颜面畸形和（或）张口困难等均痊愈或明显改善,总有效率100.00%。结论 眼眶骨折致伤原因复杂,对此类患者应详细检查、及时诊治,可有效避免并发症和后遗症。

针刺促进骨折愈合与“肾主骨”关系的初探

采用放射免疫法分期分组观察了骨折家兔的性激素、生长激素、皮质醇及垂体—甲状腺轴的变化 ,结合光镜观察甲状腺体、图像分析甲状腺滤泡 ,结果表明针刺能够促进性激素、生长激素分泌 ,抑制骨折后肾上腺皮质功能的亢进 ,解除垂体—甲状腺轴的抑制 ,其调节作用贯穿于整个骨折愈合的过程中 ,但以骨折的中、后期为著 ,说明针刺能促进骨折愈合。

爆裂性眶壁骨折45例临床分析

3年来我院治疗爆裂性眶壁骨折45例,其中手术治疗39例,非手术治疗6例.全愈28例(62%),好转13例(29%),不变4例(8.9%).文章对手术适应证,手术方法进行了讨论,并对术后残留复视的原因进行了分析.

针刺对实验性骨折愈合的影响——血液流变学及组织学观察

手术造成健康雄性家兔左侧桡骨中段 3mm骨缺损 ,术后随机分针刺组和对照组 ,以血液流变学及组织形态学为指标 ,分期观察针刺对骨折愈合的作用。结果显示 :针刺在骨折愈合的不同阶段均能改善血液流变性质 ,其中第 1周最为明显。组织学提示 :针刺组血肿机化快 ,成骨细胞增生多、激活早 ,骨痂形成速度快 ,骨折愈合的各个阶段均比对照组提前 1周左右 ,说明针刺具有促进骨折愈合的作用。

计算机辅助快速成型钛网在眼眶爆裂骨折整复中的应用

目的由于眶下壁和眶内侧壁的形态不规则,且衬垫的钛网通常是在术中由医师根据经验手工弯制和塑形,难以精确恢复眶壁的原有形态,故整复效果难以得到保障。本研究分析应用计算机辅助快速成型技术预弯的钛网修复眼眶爆裂骨折的临床疗效。方法根据11例眼眶爆裂骨折患者术前CT扫描数据,应用镜像和反求及快速成型技术3D打印出伤侧眼眶的树脂模型,在此模型上对钛网进行塑形,再通过睑下缘切口将塑形的钛网植入眶内骨折区域。通过临床和CT检查,评价其复视、眼球运动、眼球内陷和眼眶容积的恢复情况及钛网的在位情况。结果所有病例手术顺利,预弯的钛网不需要术中再次塑形和修剪,植入的钛网与眶壁贴合紧密。随访3~12个月,所有患者复视症状消失。眼眶容积得到理想恢复,容积差从术前的（2.60±0.43）m L降至（-0.07±0.62）m L,差异有统计学意义（P〈0.01）;眼球内陷得到理想矫正,突度差从术前的（2.35±0.81）mm降至（0.10±0.52）mm,差异有统计学意义（P〈0.01）。眼球运动无受限。结论应用计算机辅助快速成型技术预成型的钛网适用于眼眶爆裂骨折的整复,可精确恢复眼眶的解剖形态和容积,消除眼球内陷。

眼眶爆裂性骨折的手术治疗

目的:探讨眼眶爆裂性骨折的手术治疗方法和效果。方法:对24例眼眶爆裂性骨折患者进行复位手术,将嵌顿眶内容物复位,以钛板钛钉铆合或植入Medpor植片修补骨折缺损区,术后观察患者眼眶外观、眼球运动、视力、复视等情况。结果:术后眼球内陷改善、眼球运动改善、视力良好、复视基本消失。结论:眼眶爆裂性骨折致复视、眼球运动障碍等及时手术可获得良好眼位及视功能。

重力置换式漏喷同存机理研究

裂缝性地层在钻进过程中经常出现漏喷同存的情况,造成井控困难、井下复杂情况和储层伤害。但是,漏喷同存的机理目前还处于经验描述阶段,缺少基础理论研究和模型描述。针对直井钻遇单条裂缝时由于重力置换而引起的漏喷同存问题,研究了它的发生条件和气液两相流的流动特征,分别建立了气相模型和液相模型,并通过气液分界面将这两个模型耦合起来。模型计算与试验验证表明,对漏失速率和气体溢流量影响最大的因素是缝宽,其次是压差、钻井液流变性能;通过合理调节井筒压力和改善钻井液流变性能可减缓漏失和溢流。建立的模型与实验结果吻合较好,可为实际钻井工程中处理漏喷同存提供一定的理论依据。

针刺合电感耦合治疗骨延迟愈合、骨不连疗效观察

目的:观察针刺合电感耦合对骨延迟愈合、骨不连的治疗效果。方法:60例患者随机分为2组。观察组30例在常规治疗(包括骨折复位后夹板、石膏、聚氨酯外固定及切开复位内固定)基础上采用针刺配合电感耦合治疗,取穴以肾俞、命门、关元、气海、足三里、悬钟、太冲为主;对照组30例采用常规治疗。分别在治疗30天、120天时拍摄X线片观察骨痂生长情况。结果:观察组治疗30天、60天有骨痂生长的例数为23例、29例,而对照组分别为11例、17例,经统计学处理,观察组骨痂生长情况治疗30天及120天均明显优于对照组(P<0.05),且无不良事件和副作用发生。结论:针刺合电感耦合是促进骨折愈合的好方法。

睑板腺功能障碍患者96例的诊疗分析

目的:探讨睑板腺功能障碍(meibomian gland dysfunction,MGD)患者的诊疗方法,为临床治疗提供依据。方法:回顾性分析2012-07/2014-06在长江大学附属第一医院眼科门诊诊治的MGD患者96例192眼,裂隙灯显微镜下进行睑缘形态和功能的检查、泪膜破裂时间(BUT)、泪液分泌试验(SⅠt)检查,并进行清洁睑缘、睑板腺按摩、挤压睑板、人工泪液及抗生素和激素等综合治疗。结果:睑缘、睑脂排出情况平均评分分别为3.02±0.78,1.90±0.76。所有患者BUT均异常,平均为4.3±1.9s;84眼SⅠt正常,32眼5mm/5min<SⅠt≤10mm/5min,76眼≤5mm/5min,平均为7.9±4.4mm/5min;经治疗愈后良好,总有效率达90.6%。结论:MGD患者可引起干眼常见症状,通过睑板腺裂隙灯检查、BUT及SⅠt检查,可对患者进行及时、准确的诊断和积极治疗。

击出性骨折的诊断及治疗(附18例报告)

目的 提高击出性骨折的诊断及治疗水平。方法 回顾性总结分析我科 1999年 1月～ 2 0 0 1年 8月收治的击出性骨折病人 18例 ,其中眼球内陷 15例 ,复视 13例 ,眼球运动障碍 7例 ,视力下降 1例 ,眶下神经支配区感觉异常 5例。 2例采用保守疗法 ,另 16例均行手术治疗。根据骨折类型采用经上颌窦、经眶下、经内镜下鼻内开筛进路眶壁整复手术。结果 随访 0 .5～ 1年 ,18例病人治愈 15例 (83.3% ) ,好转 3例 (16 .7% )。

儿童眼眶爆裂性骨折的临床治疗

目的:探讨儿童眼眶爆裂性骨折的临床表现及治疗方法。方法:选取2008-03/2010-10儿童眼眶爆裂性骨折患儿12例12眼,分析其临床表现,并早期进行手术治疗。结果:患者12例大部分为摔伤后出现眼下壁骨折、下直肌嵌顿,表现为复视,CT表现为"泪滴征"。12例均早期实施手术。手术后12例复视均明显改善。其中6例于术后1wk上转逐渐恢复到位;4例于术后3mo内恢复;2例6mo内仍有上转不到位,其牵拉试验为阳性。结论:儿童爆裂性骨折多表现为下壁的裂隙性骨折,表现为眼球运动受限和复视,眼球内陷少见;外伤及手术都容易造成肌肉损伤,早期手术治疗对于肌肉功能的恢复有重要意义。

不同修复材料在眼眶爆裂性骨折中的应用

目的:观察不同的修复材料在眼眶爆裂性骨折中矫正眼球内陷及复视的效果。方法:对眼眶爆裂性骨折患者68例,采用羟基磷灰石复合体或MEDPOR外科种植体修复眼眶壁爆裂性骨折,观察不同的修复材料在术后对眼球内陷的修复效果以及复视的缓解情况。结果:68例患者中采用羟基磷灰石复合体修复30例,其中眼眶下壁骨折12例,眼眶内侧壁骨折18例。术后随访3个月至1年,1例眼眶内陷矫正欠佳;1例复视仅部分矫正;2例出现轻度下睑外翻。采用MEDPOR外科种植体修复38例,其中眼眶下壁骨折13例;眼眶内侧壁骨折25例;术后2例眼球内陷矫正欠佳;1例轻度下睑外翻。两组其余病例眼球内陷及复视均得到修复,经统计学分析差异无统计学意义(P>0.05)。使用修复材料未发现其他并发症。结论:羟基磷灰石复合体和MEDPOR外科种植体均是修复眼眶爆裂性骨折较理想的材料,修复效果好,并发症少。