眶骨延长术治疗眼球突出的实验研究

目的 探讨眶骨延长术扩大眶容积治疗眼球突出的可行性。方法 1年龄山羊6只，环行截开右侧眶壁，于眶上壁放置延长器，侧向延长1．5cm,经大体、X线、干骨标本及组织学观察成骨情况。结果 6只山羊眶骨得到不同程度的侧向延长，延长侧随着眶骨容量的增加，眼球突度较自身对照侧为小。结论 眶骨延长术可造成山羊眶骨侧向移位，有可能成为治疗眼球过度突出的方法之一。     

单纯型眶壁爆裂性骨折早期手术治疗的效果

目的 探讨单纯型眶壁爆裂性骨折早期手术治疗的方法和效果.方法 2007年1月至2013年7月,对33例（36只眼）单纯眶壁爆裂性骨折患者行修复手术治疗.应用三维CT扫描技术,明确眶壁骨折情况和特征,采用下睑睫毛缘下皮肤入路显露眶壁骨折的部位,回纳眶内容物后,采用自体骨或高密度多孔聚乙烯（Medpor）仔细填充修复眶壁缺损.结果 33例术后随访3～12个月,未出现植入骨感染、外露等并发症,眶、眼睑外形良好,眼球运动功能恢复,复视均消失.29例双侧眼球突度对称,4例患侧眼球轻度内陷.结论 眶壁爆裂骨折使眶腔容积增大、眶内容物疝出,还纳眶内容物后修复眶壁恢复眶腔容积,是治疗的最有效方法.早期CT检查是明确诊断的必要方法,对眶壁爆裂性骨折应尽早手术治疗,以避免发生并发症.     

单纯型眶壁爆裂骨折晚期畸形的诊断及整复

目的：探讨眶壁爆裂骨折所致眶壁畸形、眼球内陷的发生机制及其整复手术。方法：应用三维CT影像学技术及计算机三维诊断系统，观察眶壁畸形特征，测量眶腔容积变化，分析眼球内陷和复视的发生机制。并采用自体骨或羟基磷灰石人工骨植人恢复眶腔容积的方法进行整复。结果本组11例，未出现植人骨感染、外露等并发症。其中10例眼球突出度、眼球运动功能恢复，复视得以矫正，眶、眼睑外形良好；1例复视未得到矫正，眼球运动功能恢复欠佳。结论：眶壁爆裂骨折眼球内陷的原因主要是眶腔容积增大、眶内容疝出，还纳眶内容后植骨恢复眶腔容积，是治疗此类畸形的有效方法。     

眶骨骨折继发眼球内陷的外科治疗

目的　对眶骨骨折进行分类 ,明确导致眼球内陷的原因并采取相应的手术治疗 ,提高眼球内陷畸形的手术矫治效果。方法　所有患者术前常规X线片、眶部轴面及冠面CT检查。根据检查结果 ,将眶骨骨折主要分为两型 :Ⅰ .单纯眶壁骨折 ,眶缘完整。此类骨折的部位主要发生在骨壁薄弱的眶底及眶内壁。Ⅱ .构成眶骨的骨骼骨折移位造成的眶骨的破裂。多见于眶颧骨折和鼻筛眶骨折。对Ⅰ型骨折所导致的眼球内陷畸形经下睑睫毛缘下切口入路 ,采用自体骨或人工骨材料置入修复 ;Ⅱ型骨折所造成的眼球内陷首先将移位的骨折块截骨复位、小夹板坚强内固定 ,重建正常的眶缘并采用自体或人工材料置入同时修复眶壁。结果　自 1996年 7月 - 2 0 0 0年 10月 ,共治疗眼球内陷畸形患者 5 2例 ,其中Ⅰ型 10例 ,Ⅱ型4 2例。眼球内陷畸形均明显矫正。结论　眶骨骨折所造成的后期眼球内陷畸形主要是因为眶骨骨性容积增大所造成的眶内容物与眶骨骨性容积失衡的结果 ,可通过植骨的手段修复眶骨各壁的缺损、缩小扩大的眶腔、重建眶骨正常的解剖形态和眶容积而得以有效的矫正。     

三维眶底重建钛网修复复合性眼眶骨折患者的护理

目的总结三维眶底重建钛网治疗复合性眼眶骨折患者围术期的护理经验。方法对19例复合性眼眶骨折患者植入三维眶底重建钛网修复骨折缺损,同时给予针对性护理和定期随访。结果术后随访6～10个月,15例眼球内陷矫正,4例眼球内陷改善;17例眼球下移完全矫正,2例残留眼球下移1.0mm;12例眼球运动受限完全矫正,7例眼球运动障碍减轻;19例患者手术前后视力均无明显改变。随访期间未出现眶内感染、眶内血肿、视神经损伤、钛网排斥和移位等并发症。CT显示钛网重建骨壁位置与健侧骨壁对称。结论术前做好患者沟通和教育,术后密切观察病情,预防各种并发症,出院后加强术眼自我护理及功能锻炼,对确保治疗效果至关重要。     

Perioperative care of patients with compound fracture of the orbit managed with three-dimensional reconstruction of the orbital floor by using titanium mesh

目的 总结三维眶底重建钛网治疗复合性眼眶骨折患者围术期的护理经验.方法 对19例复合性眼眶骨折患者植入三维眶底重建钛网修复骨折缺损,同时给予针对性护理和定期随访.结果 术后随访6～10个月,15例眼球内陷矫正,4例眼球内陷改善;17例眼球下移完全矫正,2例残留眼球下移1.0 mm;12例眼球运动受限完全矫正,7例眼球运动障碍减轻;19例患者手术前后视力均无明显改变.随访期间未出现眶内感染、眶内血肿、视神经损伤、钛网排斥和移位等并发症.CT显示钛网重建骨壁位置与健侧骨壁对称.结论 术前做好患者沟通和教育,术后密切观察病情,预防各种并发症,出院后加强术眼自我护理及功能锻炼,对确保治疗效果至关重要.     

成型钛网联合Medpor治疗严重颧上颌复合体骨折后眼球内陷畸形

目的 探讨严重颧上颌复合体骨折后眼球内陷畸形的手术治疗.方法 术前常规行x线检查、眶部轴位及冠状位cT扫描,了解眶骨骨折及眶内容物移位嵌顿情况,术中将骨折移位的眶缘复位.成型钛网植入重建眶底壁,应用高密度聚乙烯(Medpor)在重建的眶底壁上充填以矫正眼球内陷.结果 2007年9月至2009年1月,共治疗严重颧上颌复合体骨折合并眼球内陷畸形患者6例,所有患者眼球内陷畸形均得以明显改善或矫正.结论 对于颧上颌复合体骨折造成的严重眶底缺损及眼球内陷畸形,可通过植入成型钛网以重建眶底壁并在重建的眶底壁上充填Medpor的方法而得以有效矫正.     

外伤性眶颧部骨折治疗50例临床分析

目的探讨根据不同的损伤类型及程度，选择性运用眶周截骨术及眶内充填术，对50例眶颧部骨折患者的整复治疗效果。方法根据眶颧部骨折的不同损伤程度，采用眶壁眶缘截骨术，恢复眼眶的解剖结构，并根据骨块复位程度．选用自体或医用材料进行眶周和眶内骨膜下充填，修复眼眶。结果50例患者术后双侧眼球突出度、面中部对称性，宽度等均较手术前有明显改善。本组有2例长期复视，5例术后有轻度眼球凹陷。结论眶周截骨复位术，辅助选用眶内材料充填可以有效矫正陈旧性眶颧部骨折畸形。     

眶壁爆裂性骨折的手术治疗

目的 探讨眼眶壁爆裂性骨折手术治疗的方法和效果.方法 总结我院1998年8月至2007年1月,因眼眶壁爆裂性骨折而行修复手术治疗的患者81例(85只眼).结果 所有患者术后随访6～24个月,52例眼球运动障碍患者中,31例眼动恢复正常,复视消失.其中伤后2周内手术者21只眼,占75.0%(21/28).2周至2个月者8只眼,占44.4%(8/18).超过2个月者2眼,占33.3%(2/6).超过2周以上者眼球内陷的术前均值3.5 mm,术后均值1.5 mm,明显改善.眶内填入材料种类与矫正眼球内陷的效果无明显关系.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2 mm,即应手术矫正.手术应于骨膜下进行,以避免并发症.骨水泥和MEDPOR使用起来安全,效果肯定.     

陈旧性眶颧骨折合并眼球内陷的治疗

目的：探讨陈旧性眶颧骨折后眼球内陷的整复治疗。方法：术前常规行x线检查、眶部轴面及冠状位扫描及三维重建,了解眶颧骨骨折及眶内容物移位嵌顿情况。术中首先暴露骨折部位,将移位的骨折块截骨复位、微型钛板坚强内固定,重建正常的眶缘;用自体或人工材料植入,同时修复眶壁。结果：所有病例眼球内陷均得以明显改善或矫正,颧部外形明显改善,眼球运动功能得以恢复,CT显示眶结构恢复良好,内直肌及下直肌位置及形态正常,视神经无受压。结论：陈旧性眶颧骨折所致晚期眼球内陷畸形可通过截骨复位、植入自体或人工材料重建眶缘,修复眶骨各壁的缺损获得有效矫正。     

rhBMPs对山羊下颌骨较大速率DO成骨的影响

目的研究在下颌骨较大速率牵引成骨术(DO)中应用重组人骨形成蛋白(rhBMPs)对成骨的影响,探讨下颌骨较大速率DO的可行性。方法12只山羊双侧下颌骨行DO,山羊及左右下颌骨随机化分为实验侧、对照侧,一只山羊作为正常标本。术中预置牵开间隙3.5mm,实验侧应用rhBMPs,延迟期为3d,牵引速率为1.5mm/d,分3次牵引,延长幅度为20mm。3、5、7、12周行大体、X线、骨密度、生物力学和组织学观察。结果延长幅度达到20mm,自固定期3周开始观察,牵引间隙新骨的再生形成及成熟改建仍是连续的骨愈合过程。固定期5周时,大体及X线观察表明实验侧已形成良好的骨皮质连续性,密度近于正常骨,而对照侧牵引间隙中间区却存在骨不连或间隙存在。组织学显示DO过程仍然是膜内成骨,对照侧牵引间隙中央可见中央区纤维连接、软骨改变,周边区可见新骨组织形成。生物力学三点弯曲实验显示实验侧在5周时接近正常骨,与对照侧有显著差异。骨密度随时间递增,实验侧在各时间点均高于对照侧。本实验条件下在5周后拆除牵引器较为可靠。结论较大速率DO的骨再生形成也是一个连续的膜内成骨过程。rhBMPs在较大速率和较大幅度DO中的应用能够加速骨的再生和愈合速...     

延长成骨术修复颅骨缺损的实验研究

目的探讨以延长成骨修复颅骨缺损的可行性。方法随机挑选1岁龄山羊17只,分为A、B、C三组,A组7只,于顶骨处左右各形成一大小相等面积为3.0 cm×2.2 cm矩形骨缺损;B组5只,于顶骨处右侧形成一2.2 cm×2.2 cm的正方形骨缺损;C组5只,于顶骨处左右各形成一大小为3 cm×1 cm矩形骨缺损。各组于右侧骨缺损形成相应的转移骨瓣并安放延长器,A组三维CT对修复颅骨面积进行测量;B组行成骨后生物力学测量;C组行组织学染色、扫描电镜、透射电镜检查观察成骨过程。结果A组可见实验侧骨缺损大部分逐渐被延长成骨所修复,剩余少量骨缺损与自身对照有统计学意义(P<0.01),B组实验侧与正常对照侧无统计学意义,C组观察成骨过程,为典型的膜内成骨。结论延长成骨术是一种可行的修复颅骨缺损的方法。     

内置式山羊下颌骨二维牵张器的实验研究

目的：探讨用自行研制的内置式二维牵张器在山羊下颌骨上进行二维牵张的可能性。方法：进行离体实验预牵张;建立山羊下颌骨二维牵张的动物模型,牵引过程中拍摄X线片以监测牵张进度和牵张间隙内戍骨情况,牵张结束后和固定8周后进行HE染色做组织学观察。结果：离体实验可以完成整个牵张过程;4只山羊成功建立下颌骨二维牵张动物模型,牵张间隙内新骨形成确切,X线片和组织学切片均显示固定8周后新生骨已经接近正常骨质。结论：自行设计的内置式山羊下颌骨二维牵张器可以完成山羊下颌骨的二维牵张成骨并可能具有一定的临床应用价值。     

Locally applied nerve growth factor enhances bone consolidation in a rabbit model of mandibular distraction osteogenesis.

Distraction osteogenesis is widely used in treating deformities, defects, and fractures of both long bones and craniofacial bones. Demands for acceleration of bone consolidation are increased in distraction osteogenesis. Nerve growth factor (NGF) can enhance innervation and bone regeneration in a fracture model and stimulate differentiation of osteoblastic cells. In this study, we tested the ability of locally applied NGF to enhance bone regeneration in a rabbit model of mandibular distraction osteogenesis. Twenty rabbits underwent bilateral distraction osteogenesis with a rate of 0.5 mm per 12 h. Two times 0.04 mg human NGFbeta (hNGFbeta) in buffer was injected into the callus after distraction. The contralateral side received placebo injections. Rabbits were euthanized at consolidation times of 14 and 28 days. Specimens were subjected to radiography, callus dimensions measurement, mechanical testing, and bone histological and histomorphometric analysis. The maximum load, bone volume/total volume, mineral apposition rate of the 1st to 11th day, and mineralized bone percentage were significantly higher in the hNGFbeta side at 14 and 28 days (p<0.05). The data indicate that locally applied hNGFbeta can accelerate callus maturation and may be an option to shorten the consolidation period in distraction osteogenesis.     

Histomorphometry of distraction osteogenesis during experimental tibial lengthening

OBJECTIVES: The aim of the current study was to analyze distraction osteogenesis histomorphometrically to investigate the amount of enchondral ossification adjacent to intramembranous ossification. STUDY DESIGN: Species-specific, longitudinal time study.METHODS Lengthening of 25% of the right tibia was performed in 24 beagle dogs by callus distraction after osteotomy and application of a ring fixator. Distraction was started at the fifth postoperative day with a distraction rate of 0.5 mm twice a day. Twelve dogs were killed at the end of the distraction phase of 25 days (group A) and the remaining 12 dogs after an additional consolidation period of 25 days (group B). The tibia was removed from the distracted right leg and from the left control side of each animal, and longitudinal sections were cut and stained with Pentachrome. In all tibiae, an area of 0.5 x 2.4 cm within the endosteal bone was evaluated histomorphometrically with a Merz grid, and the results were compared between distraction and control side as well as between the dogs of group A and group B. RESULTS: On the distraction side, the typical signs of an increased de novo bone formation with a significant increase of osteoblasts and osteoid in group A, as well as an additional significant increase of bone volume and trabecular thickness in group B, were found. In all distraction cases, islands of cartilage formation, which underwent enchondral ossification, were found, besides membranous ossification. The ratio between membranous and enchondral ossification was found to be five to one. CONCLUSION: Bone formation during distraction osteogenesis results from both membranous and enchondral ossification.     

应用单边外固定支架矫正胫骨近端内翻畸形

目的 探讨应用单边外固定支架矫正胫骨近端内翻畸形的疗效.方法 2004年7月至2010年8月应用单边外固定支架治疗5例胫骨近端内翻畸形患者,男2例,女3例;年龄18～42岁,平均32岁.胫骨平台骨折与胫骨近端骨折畸形愈合各2例,胫骨近端截骨延长后出现牵开骨痂的畸形愈合1例.术中对腓骨进行截骨,在胫骨安装外固定支架,并在胫骨近端进行截骨.术后7～10 d通过外固定支架逐渐牵开并纠正成角畸形.结果 所有患者术后获5～11个月(平均8.4个月)随访.1例患者牵开处不愈合,经植骨治疗后愈合;其余4例均愈合,愈合时间为3～6个月,平均4.8个月,带架时间为4～8个月,平均6.8个月.所有腓骨截骨端均愈合,针道除并发轻微反应外无严重并发症,手术与矫正过程中未出现神经损伤等并发症.机械轴偏向矫正后较健侧平均外移8 mm(1～13mm).胫骨近端内侧角矫正后平均为90°(87°～92°).矫正后患侧肢体和健侧差异为-6～1 mm,胫骨和健侧长度差异为-2～3 mm.结论 单边外固定支架能够成功矫正胫骨近端内翻畸形愈合,与传统的外翻截骨内同定相比,它具有创伤小、无需植骨及截骨方法简单的优点,逐渐矫正能获得更准确的力线,同时可矫正肢体短缩、避免再次手术.

Abstract：

Objective To review gradual correction of proximal tibial varus malunion with a unilateral external fixator for osteogenetic distraction. Methods From July 2004 to August 2010, we treated 5 cases of proximal tibial varus malunion with a unilateral external fixator. They were 2 men and 3 women,with an average age of 32 years (from 18 to 42 years). Two cases were malunion after tibial plateau fracture,2 after proximal tibial fracture, and one after osteogenetic distraction. After fibular osteotomy, a tibial unilateral external fixator was installed before proximal tibial osteotomy. Varus was corrected for 7 to 10 days after surgery by gradual distraction till the same alignment was obtained as the contralateral side. The external fixator was not removed until consolidation and full weight bearing. Results The follow-ups ranged from 5 to 11 months (average, 8. 4 months). Four cases got united after 3 to 6 months (average, 4. 8 months).Time for external fixator ranged from 4 to 8 months (average, 6. 8 months) . One case obtained bone union after bone grafting. All fibulas healed after osteotomy. No other complications were present except mild pin-tract problems. Compared with the contralateral side, the corrected malalignment deviation was laterally displaced by 8 mm on average (from 1 to 13 mm), the corrected medial proximal tibial angle was 90° on average (from 87° to 92°), the limb length discrepancy was -6 to 1 mm, and the tibial length discrepancy was - 2 to 3 mm. Conclusions Proximal tibial varus malunion can be corrected gradually and effectively by a unilateral external fixator. Its advantages over valgus osteotomy and internal fixation are less invasion due to simple transverse osteotomy, accurate correction not only of angulation but also of length discrepancy, and no need of bone grafting or implant removal.     

Bone regenerate formation in cortical bone during distraction lengthening. An experimental study

The aim of this study was to delineate the pattern of bone regeneration from cortical bone segments during distraction lengthening. The lengthening procedure was applied for various periods through the Ilizarov system on the forearms of mature dogs. Bone was sectioned either by corticotomy, preserving the nutrient artery integrity, or by osteotomy. When an osteotomy was performed, the marrow cavity was in some cases plugged with either resorbable bone wax or nonresorbable material. Under distraction, both periosteal and medullary callus on either side of the gap gave rise to new bone trabeculae. The trabeculae on either side were oriented along the direction of distraction and progressively approached one another. This striated callus emerging from both sides was the most characteristic pattern of bone regeneration subsequent to distraction lengthening. Fusion was achieved approximately four weeks after the end of the lengthening period. Most of the new bone was formed by membranous ossification; some cartilaginous nodules developed. Corticalization of the bone trabeculae that had begun at three months was not fully achieved at five months after the lengthening period. There were no differences found in the pattern of bone healing and the amount of newly formed bone after corticotomy or osteotomy with or without resorbable bone wax plugging.     

骨基质明胶影响狗下颌骨牵张成骨的实验研究

目的探讨在牵张区截骨部位加入骨基质明胶（Bone matrix gelatin，BMG），以诱导骨的再生，促进牵张区骨痂愈合，并缩短间歇期及固定期，提高成骨质量，减少并发症。方法选用6只雄性成年杂种狗，随机选取一侧作为实验组（牵张区截骨部位加入BMG），另一侧作为对照组。分别在下颌骨体部安放牵张器，共牵张7d，通过不同时间点的X线观察、组织学观察和灰度分析来评价骨牵张的程度。结果计算机辅助灰度间接计量统计学分析结果：第1周时，对照组和实验组的骨密度间接计量值，两者比较差异无统计学意义。第3周、5周、8周时，对照组和实验组的骨密度间接计量值，两者比较，差异有统计意义。结论在牵张区截骨部位加入BMG，能够诱导骨的再生，可促进牵张区骨痂愈合，缩短牵张成骨整个过程．提高成骨质量，减少并发症。