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.

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.

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.

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。

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。

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。

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。

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。

眼眶骨折的临床治疗分析

目的:研究不同类型的眼眶区骨折的治疗方案,探讨不同类型眼眶骨折的最佳治疗方法。方法:回顾性总结2001/2006眼眶区骨折患者共80例;按复位—眼眶—分类法分为Ⅰ～Ⅵ型,采用保守治疗和手术治疗的方法。将保守治疗无效且拒绝手术患者和接受手术的患者疗效进行比较性研究。结果:开放性骨折2例行1期手术,术后无明显复视和眼球凹陷。78例早期均先采用保守治疗,保守治疗包括使用大剂量皮质类固醇激素,高渗脱水剂、神经营养药物等,有41例复视消失或减轻,眼球内陷小于2mm,保守治疗的总有效率为52%。有37例复视、眼球内陷、眼面部畸形仍明显的患者被告知手术的必要性,其中有17例患者接受手术治疗,眼部畸形改善、复视显著改善或消失16例。20例未接受手术,眼部畸形改善、复视显著改善或消失3例。经Fisher精确率检验将两组患者疗效比较,有效率的差异有显著性。结论:对于全身情况允许的开放性骨折患者1期手术内固定可以得到良好效果;保守治疗是Ⅰ型眶区骨折的首选方法;手术内固定眶壁重建术是Ⅱ～Ⅵ型眶区骨折的较好方法。

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。

经结膜爆裂性眼眶骨折修补术的手术时机

目的:探讨经结膜爆裂性眼眶骨折修补术的手术时机、治疗效果及并发症。方法:回顾21例施行经结膜眼眶骨折修补术的眼眶爆裂性骨折患者,据伤后手术时间,分为早期组12例、晚期组9例,比较复视、眼球突出度、眶下神经感觉障碍情况,并记录并发症。结果:复视恢复情况:总体治愈情况(16/21,76.2%);早期治疗组治愈率(10/12,83.3%)与晚期治疗组治愈率(6/9,66.7%),两组间比较差异有统计学意义(P<0.05);眼球突出度恢复情况:总体治愈情况(17/21,81.0%);早期组治愈率(10/12,83.3%)与晚期组治愈率(7/9,77.8%),两组间比较差异无统计学差异(P>0.05);眶下神经感觉障碍情况:总体治愈率(12/21,57.1%);早期治疗组治愈率(7/12,58.3%)与晚期治疗组治愈率(5/9,55.6%),两组间差异无统计学意义(P>0.05)。结论:经结膜切口入路修补眼眶爆裂性骨折是一种手术时间短、损伤小、无皮肤瘢痕、并发症少的方法,值得推广和应用,手术时机在伤后2wk内保守治疗无效情况下为适。

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。

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。

预成形钛网修复眼眶内、下壁联合骨折的临床观察

目的探讨预成形钛网经单一下睑缘切口治疗眼眶内、下壁联合骨折的临床效果及其安全性。方法回顾性总结2008年1月至2009年6月收治的18例眼眶内、下壁联合骨折患者。术前眼球内陷(与健眼差值-3～-6mm)18例,眼肌运动受限8例,复视6例。所有患者均经下睑缘皮肤切口行眶壁骨折整复术,植入预成形钛网修复骨折缺损。术后随访6～12个月,平均8.9个月。术前、术后行眼眶CT水平及冠状位扫描并进行比较。结果眼球内陷矫正(与健眼突出度差值≤±1.5mm)14例,眼球内陷改善(与健眼差值-2～-3mm)4例;眼球运动受限完全矫正5例,明显改善3例;5例患者复视完全消失,1例患者复视有所改善。18例患者手术前后视力无明显改变,未出现溢泪、钛网感染、排异和移位等并发症。CT显示钛网重建骨壁位置与健侧骨壁对称。结论应用预成形钛网治疗眼眶内、下壁联合骨折安全、有效,且钛网重建骨壁位置更加精确、稳定。

114例眼眶骨折分析

目的:探讨眼眶骨折的诊断和治疗原则。方法:回顾分析了114例眼眶骨折的患者,分类统计其临床表现和治疗方法。结果:眼球运动障碍、复视和眼球内陷发生率分别为63.2%、62.3%和59.6%;视神经损伤、泪道损伤和眼球破裂的发生率分别为15.8%、15.8%和12.3%。95.6%的患者接受了眶壁整复和人造骨植入术;72.8%的患者进行了骨折复位内固定术;部分患者进行了视神经减压术、眼球修补术和泪道手术。结论:眼球运动障碍、复视和眼球内陷是眼眶骨折的主要临床表现,视神经损伤、眼球破裂和泪道损伤亦不能忽视;眶壁整复和人造骨植入术是眼眶骨折治疗的主要术式,非单纯性眼眶骨折还需行骨折复位内固定术。

眼眶爆裂骨折的CT诊断(附226例报告)

目的 :回顾性复习眼眶爆裂骨折的CT资料 ,探讨CT检查方法对眼眶爆裂骨折的显示及诊断价值。方法 :对226例患者行CT冠状位扫描和/或横断扫描 ,分析其CT表现的直接和间接征象。结果 :本组226例病例 ,其中单纯内壁骨折105例 (占46.46 % ),单纯下壁骨折13例 (占5.75% ),双壁 (内、下壁 )骨折23例 (占10.18 % ) ,眼眶复合型骨折85例 (占37.61 % )。眼眶爆裂骨折CT表现的直接征象为眶壁骨质断裂移位、粉碎和曲度异常。眼眶爆裂骨折CT表现的间接征象中眼外肌改变及眶内肌锥外积气在骨折中发生率较高。结论 :冠状CT扫描是眼眶爆裂骨折的首选检查方法 。