应用AO三维预成型钛网治疗眼眶骨折的临床研究

Clinical use of AO three-dimensionally preformed titanium mesh plates for orbital fractures

摘要:

目的：评价三维预成型钛网在单纯性眶壁骨折修复中的精确性和可行性。

方法：本研究共包括47例单纯性眶壁骨折患者，骨折部位如下：内下壁联合骨折26例(55%)，单纯眶内壁骨折12例(26%)，单纯眶下壁骨折9例(19%)。对于眶下壁骨折，采用标准的经下睑结膜入路； 而对于眶内壁骨折和内下壁联合骨折，则采用经泪阜、经下睑结膜联合入路，同时暂时切断下斜肌将两切口沟通。所有患者均充分暴露骨折边缘并还纳疝出的眶内组织后，根据术前CT测量的骨折缺损范围，选择对应型号的AO三维预成型钛网并进行适当的修剪和弯制后植入眶内，使用两颗钛钉将钛网固定于眶下缘。通过术后复查眼眶三维CT来评价植入钛网的精确性，通过对患者术前和术后的临床资料的对比来评价预成型钛网临床应用的可行性。

结果：术后CT表明，所有患者的眼眶骨折在植入三维预成型钛网后均得到比较精确的解剖修复。所有患者在术中、术后均未出现严重的并发症，40例(87%)患者眼球内陷得以矫正，25例(86%)患者复视消失。

结论：AO三维预成型钛网在解剖上可比较精确地修复眶壁骨折； 在临床上，可以显著改善眼球内陷和复视。

Abstract:

AIM:To evaluate the accuracy and practicability of three-dimensionally preformed Arbeitsgemeinschaft Osteosynthese AO titanium mesh plates for orbital fractures.

METHODS:Forty-seven patients with isolated blow-out orbital fractures were included in this study. Fracture locations were as follows: floor/medial wall(n=26, 55%), medial wall(n=12, 26%), and floor(n=9, 19%). The floor fractures were exposed by a standard transconjunctival approach, whereas a combined transcaruncular transconjunctival approach was used in patients with medial wall fractures with temporary dissection of inferior oblique muscle. A three-dimensionally preformed AO titanium mesh plate was selected according to the size of the defect previously measured on the preoperative computed tomographic scan examination and fixed at the inferior orbital rim with 2 screws. The accuracy of plate positioning of the reconstructed orbit was assessed on the postoperative computed tomography(CT)scan. The practicability of clinical use of AO three-dimensionally preformed titanium mesh plates was assessed on the preoperative and postoperative clinical data.

RESULTS: Postoperative orbital CT scan showed an anatomic three-dimensional placement of the orbital mesh plates in all of the patients. All patients had a successful treatment outcome without clinical complications. 40 patients(87%)had a successful enophthalmos correction. 25 patients(86%)had a successful recovery from diplopia.

CONCLUSION: Three-dimensionally preformed AO titanium mesh plates for orbital fracture reconstruction results in an accurate anatomic restoration of the bony orbital contour with a high rate of success to correctenophthalmos and diplopia.