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.

Orbital Floor Fractures: Epidemiological, Clinical and Therapeutical Study at Sylvanus Olympio University Teaching Hospital in Loméabout 51 Cases

Introduction: Orbital floor fractures are a significant pathology among maxillofacial injuries. They can cause oculomotor, sensory, and sometimes esthetic disorders. The goal of this study was to determine the epidemiological profile of orbital floor fractures and show their clinical and therapeutic approach in Lomé. Patients and method: This was a descriptive retrospective study of orbital floor fractures collected in the ENT and maxillofacial surgery department of Sylvanus Olympio University Hospital in Lomé over 8 years (January 1, 2011 to December 31, 2018). Results: We reviewed 63 cases of orbital floor fractures out of 552 cases of facial trauma. According to the inclusion and non-inclusion criteria, we retained 51 cases. The hospital frequency of orbital floor fractures was 9.24% of facial fractures. The average age of the patients was 35 ± 10.34 years. Males were predominant (ratio = 7.5). The main etiology was road accidents (92.16%). Ophthalmological signs were dominated by vertical diplopia (31.37%), limited eye movement (25.49%), and enophthalmia (29.41%). The sensory sign was dominated by suborbital hypoesthesia (13.73%). Surgical treatment was performed in 86.27% of patients. The average intervention time was 17.84 ± 12.69 days after the trauma. The main approach was the subciliary route (65.91%). The surgical procedures consisted of muscle and fat removal (20.45%) and orbital floor repair by mesh plate (50%). The average length of hospitalization was 9.63 ± 5.23 days. Surgical site infection was the main postoperative complication observed in 3.92% of patients. The main sequelae were diplopia (4.55%), suborbital hypoesthesia (4.55%), and enophthalmos (4.55%). Conclusion: Orbital floor fractures are mainly due to road accidents. Management must be multidisciplinary and adequate in order to avoid irreversible functional and/or morphological sequelae. Their prevention consists of effective combat of road accidents.

眼外肌功能训练对改善眼眶骨折整复术后复视的影响

目的评价术后眼外肌功能训练对眼眶骨折整复术后复视症状恢复的效果。方法选取行眼眶骨折整复术患者66例,随机分为对照组和干预组各33例。对照组执行常规治疗与护理,干预组在对照组的基础上指导患者术后眼外肌功能训练。比较2组干预前和干预后1周、1个月、3个月、6个月的复视情况与患者对护理的满意度。结果术后1周、1个月、3个月及6个月干预组患者0级复视率均高于对照组(P<0.05)。住院期间,干预组患者对护理的满意度高于对照组(P<0.05)。结论眼外肌功能训练有助于眼眶骨折整复术后患者改善复视症状。

眶底爆裂性骨折修复术后持续性复视相关因素分析

目的分析眶底爆裂性骨折修复术后持续性复视的影响因素。方法采用病例对照研究,收集2011年7月至2020年7月在河南省立眼科医院诊治的术后1 d即存在复视的眶底爆裂性骨折患者146例146眼的病历资料,根据观察期间内复视是否持续存在分为持续复视组14例14眼和复视消失组132例132眼,比较2个组不同性别、眼别、年龄、术前病程、术前眶内软组织嵌顿程度、手术方法、手术入路、术后眼球转动锻炼依从性、术后下直肌损伤程度眼数的差异,筛选P<0.05的因素进行多因素Logistic回归分析。结果所有患眼均成功地进行了手术,术后随访期间所有患眼均未出现眼眶植入物感染、移位等并发症。2个组间不同年龄分类、术前病程、术前眶内软组织嵌顿程度、手术方法、术后眼球转动锻炼依从性、术后眼外肌损伤程度眼数比较,差异均有统计学意义(χ^(2)=9.443,P=0.002;χ^(2)=29.041,P<0.001;H=53.943,P<0.001;H=34.583,P<0.001;χ^(2)=46.041,P<0.001;H=101.438,P<0.001)。多因素Logistic回归分析结果显示,术前长病程(OR=8.678,95%CI=1.013~74.304,P=0.031)、术前眶内软组织嵌顿(重度:OR=32.963,95%CI=7.647~142.084,P<0.001.中度:OR=11.852,95%CI=2.679~52.436,P=0.001)、术后下直肌损伤(重度:OR=511.000,95%CI=42.815~6110.808,P<0.001.中度:OR=132.000,95%CI=12.442~1400.458,P<0.001)是术后持续性复视的独立危险因素。先进的手术方法(个体化塑形钛网法:OR=0.020,95%CI=0.002~0.127,P<0.001.厂家预制钛网法:OR=0.031,95%CI=0.004~0.257,P=0.001)、术后眼球转动锻炼依从性良好(OR=0.015,95%CI=0.001~0.197,P<0.001)是术后持续性复视的独立保护性因素。结论眶底爆裂性骨折修复术前严重眶内软组织嵌顿和术后下直肌的不可逆损伤是术后持续性复视的主要危险因素,缩短术前病程、改善手术方法、增强术后眼球功能锻炼可降低术后持续性复视的发生率。

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。

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.

眼眶骨折修复手术对复视和眼球运动障碍的改善

目的观察眼眶骨折患者手术治疗前后复视和眼球运动障碍的改善情况。方法回顾62例因眼眶骨折实施修复手术患者的临床资料。所有患者经眼眶CT明确骨折的部位、范围及眼外肌嵌顿情况。分别于术前和术后3、6、12个月检查并记录复视和眼球运动情况。结果62例眼眶骨折中23例为单纯眶壁骨折,其中18例术前有复视,19例出现Ⅰ级或Ⅱ级眼球运动障碍;术后12个月时,仅5例残留Ⅰ级或Ⅱ级复视,5例有Ⅰ级眼球运动障碍。39例复合性眼眶骨折中,其中36例术前有复视,38例发生眼球运动障碍;术后12个月时,29例有复视(6例为Ⅲ级复视),22例有眼球运动障碍。术后12个月时,伤后3周内施行手术修复的12例患者中仅1例为Ⅲ级复视,而3个月后施行手术的23例患者中有5例为Ⅲ级复视。结论手术修复眼眶骨折能够有效改善眼球运动功能和复视程度,早期手术疗效优于晚期手术。

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。

眼眶爆裂骨折的CT表现及法医学鉴定分析

目的研究眼眶爆裂骨折的CT表现特点及其法医学鉴定问题。方法对76例眼眶爆裂骨折的临床法医学鉴定案例进行回顾性分析、总结。结果单纯头部CT以及X线检查诊断眼眶爆裂骨折漏诊率较高,其中CT诊断阳性率高于X线;眼部CT检查是诊断眼眶爆裂骨折的首选方法。76例骨折中以眶内侧壁骨折多见,其次为眶下壁骨折。CT直接征象主要表现为眶壁骨质连续性中断和眶壁移位,间接征象主要为骨折处积血和软组织增厚;临床表现以眼周瘀斑、肿胀、视力下降及复视为主。眼眶爆裂骨折对伤眼视力影响不明显,患者伤后视力多在0.8以上,但是容易出现复视;损伤程度以轻伤为主。结论单纯头部CT及X线检查诊断眶壁爆裂骨折有局限性,对眼部损伤患者,建议法医鉴定时将眶部CT检查作为常规;眶壁骨折对伤眼视力影响不明显,但是容易出现复视,法医鉴定时应引起注意。

眶爆裂性骨折36例临床诊治分析

目的探讨眼眶爆裂性骨折的临床特点和诊治方法。方法对2000年9月~2004年6月36例(36眼)眶爆裂性骨折的临床资料进行回顾性分析。结果致伤原因为拳击伤18例,车祸伤15例,其它3例。眼部临床症状和体征主要有复视、眼球运动障碍及眼球内陷等。CT检查均有阳性发现。术后复视治愈32例。32眼眼球活动度完全改善,4眼部分改善。术后伤眼眼球突出度增至10.5~15.0mm,平均13.5mm;术后伤眼与健眼眼球突出度差为+1.5^-2.0mm,平均+1.0mm。术后无并发症发生。结论CT扫描对眼眶爆裂性骨折的诊断有重要价值。术后早期进行眼球运动训练对提高复视的治愈率、改善眼球的运动功能有重要作用。

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。

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。

应用个体化预成型钛网修复眶下壁骨折的临床分析

目的:探讨个体化预成型钛网修复眶下壁骨折的应用效果。方法:对下壁眼眶骨折患者共67例67眼采用个体化预成型钛网进行手术修复,术后随访期为1a,监测切口愈合情况、视力、眼球运动度、复视及眼球突出情况。结果:术后随访期间无感染,无钛网移位、脱出、变形及排斥等并发症,无下睑外翻病例发生。眼球内陷均达到双眼球突出度对比相差小于2mm。术后随访1a,所有患者眶下壁骨折全面修复。眼球运动无受限,各方向运动到位。复视者5例中复视完全消失4例,明显改善1例,2例眼球下移者下移均消失。术后视力与术前对比无明显变化。第一眼位复视消失率为93%,另外3例患者明显改善,周边视野复视消失率为86%,另2例患者明显改善。结论:应用个体化预成型钛网进行眶下壁骨折修复效果满意,安全性好。

眼眶爆裂性骨折术后眼球运动训练辅助牵拉试验效果观察

目的观察单纯眼球运动训练和眼球运动训练辅助牵拉试验在眼眶爆裂性骨折术后患者眼肌力训练中的应用及对患者视功能的改善作用。方法143例眼眶爆裂性骨折修复术后患者分为试验组63例和对照组80例，试验组在术后第1-3天给予眼球运动训练辅助被动牵拉试验；对照组单纯给予眼球运动训练。观察两组患者的复视改善情况。结果试验组有效率为93．6％（59／63），明显优于对照组的72．5％（58／80，P＜0．01）。结论眼球运动训练辅助牵拉试验可促进眼眶爆裂性骨折术后患者视功能的改善。

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。