预成钛网在伴发眼球破裂眼眶骨折眶壁重建中的应用

摘要

Objective: To analyse the character of the orbital fractures associated with eyeball rupture and evaluate the application of the CAD/CAM technique in the orbital reconstruction.Methods: 8 patients with orbital fracture accompanying eyeball rupture were treated.CT scan was taken for all the patients preoperatively and postoperatively.Surgical simulation was performed based on the CT data under the help of software.The pre-bent titanium mesh was manufactured and grafted to the traumatic orbital walls.Results:Based on the analysis of the preoperative CT scanning, the defect of the orbital wall and the herniation of the orbital soft tissue were serious in all the cases.Most of the fractures were impure.The orbital reconstruction was satisfactory in all the patients according to the postoperative CT data and no serious complication was found.The volume of the herniated soft tissue was reduced from 3.8 ml to 1.1ml and the postoperative degree of enophthalmos was less than 3 mm in 7 of the 8 cases.Conclusion: The herniation of the orbital soft tissue and the traumatic degree are serious in the orbital fracture associated with eyeball rupture.The pre-bent titanium mesh is effective in the orbital reconstruction.%目的:通过回顾性分析,总结伴发眼球破裂的眼眶骨折的损伤特点,初步评价预成钛网在其眶壁重建中的应用效果.方法:2004-09～2008-05在北京大学口腔医学院创伤中心接受治疗的罹患合并眼球破裂眼眶骨折病例共8 例.术前借助计算机软件,基于CT数据,通过镜像的方法制作预成钛网,行眶壁重建术,术后再次CT分析,评价眶壁重建的精确性和眼球突度恢复情况.结果:8 例患者7 例在眶壁重建前由眼科完成眼球摘除,1 例与眶壁重建同期完成.所有病例均成功的实施了眶壁重建,术后未发生严重并发症.CT分析显示,该组病例在眼球内陷、眶壁缺损、骨性眶腔扩大和眶内软组织疝出等方面均较严重.手术后,眶内软组织疝出体积平均减小2.7 ml,整体眶腔容积平均缩小2.9 ml,87.5%(7/8)的病例眼球内陷矫正至3 mm以内.结论:伴发眼球破裂的眼眶骨折具有创伤严重、骨性眶腔扩大显著和眶内软组织体积降低明显等特点,预成钛网的应用可达到较为精确的眶壁重建.