摘要
目的评价导航系统在单侧眼眶骨折眶壁重建中的应用效果。方法在导航指导下完成眶壁重建的15例单侧眼眶骨折患者纳入研究，其中，男性7例，女性8例，平均年龄（34．3±9。5）岁。术前CT扫描、数据导人BrainLa_b导航系统工作站、以健侧眼眶CT数据的镜像作为参考，完成术前设计。对粉碎性严重眶壁骨折则以镜像数据为基础，制作模板并在模板上完成钛网预成形；如眶壁骨折较局限，则采用羟基磷灰石补片在术中直接完成眶壁缺损修复。在导航系统的指导下分别以钛网（10例）、羟基磷灰石补片（5例）完成眶壁重建。术后再次CT扫描，评价导航系统应用效果4个变量：①整体眶腔容积差；②眶壁疝出组织体积；③眼球内陷程度；④重建误差。由于羟基磷灰石在CT中显像效果差，因此，只测量钛网移植病例的重建误差。结果所有病例均未出现视神经损伤、感染或植入体排斥等并发症。经测量术前平均眼球内陷（3．54±1．6）mm、整体眼眶容积差（4．5±1．8）ml、疝出组织体积（2．1±O．7）ml；术后以上3项指标分别降低到（1．3±0．6）mm、（1．8±0．9）ml和（0．7±0．3）111l。统计学测量显示，眶内壁和下壁的重建误差分别为（2．5±0．6）mm和（2．1±Q4）mm。结论单侧眼眶骨折治疗应用导航系统可以得到精确的眶壁重建和满意的治疗效果。
Objective To evaluate the efficiency of navigation system for orbital wall reconstruction in unilateral orbital fractures. Methods Fifteen patients （7 male and 8 female ） with unilateral orbital fracture underwent orbital reconstruction with the help of intraoperative navigation system. The average age was 34. 3 ± 9. 5 years. All patients underwent spiral CT scanning preoperatively, and the CT data was imported to the BrainLab navigation system （Germany, BrainLab company）. The orbit of the intact side was mirrored to the opposite side as the reference for pre-operative planning. The titanium mesh was mounted on the resin template made by rapid prototyping machine based on the mirrored CT data. When the injury was limited, the hydroxyapatite sheet was used for the orbital wall reconstruction. During the operation, the real-time navigation helped to ensure precise placement, The re-establishing result was assessed based on the postoperative CT data with the following four variables： the volumetric difference between the bilateral orbit, the volume of the herniated soft tissue, the global projection and the discrepancy between the simulated and the achieved position of the reconstructed orbital wall. The reconstructive discrepancy was measured only in the titanium plate grafting cases. Results There were no serious complications such as infection, graft rejection and optic nerve injury in any case. Preoperatively, the average degree of enophthalmos was（3.5 ± 1.6） mm, the average volumetric difference between the injured and the unaffected orbit was （4. 5 ± 1.8） ml, and the average volume of the herniated orbital soft tissue was （2. 1 ± O. 7） ml. Postoperatively, the three values were respectively reduced to （ 1.3 ± 0. 6） mm, （ 1.8 ± 0. 9） ml and （0. 7 ± 0. 3） ml. The discrepancy of the medial and inferior wall were （2. 5 ± 0. 6） mm and （2. 1 ± 0. 4） ram. Conclusions The intraoperative use of navigation system for the orbital wall reconstruction in unilateral orbital fractures can provide reliable accuracy and achieve satisfactory results.
出处
《中华口腔医学杂志》
CAS
CSCD
北大核心
2012年第11期657-661,共5页
Chinese Journal of Stomatology
关键词
眶骨折
治疗
计算机辅助
眶壁重建
Therapy, eomputer-assiste
Orbital fraetures
Navigation system Orbitalreeonstrution
