Medpor在眼眶重建和眼球内陷复位手术中的应用

目的：评价Medpor在眼眶爆裂性骨折的眼眶重建和眼球内陷复位手术中的应用效果，探索充填手术技术。方法：在术前应用CT扫描和CT三维重建技术，评估眼眶骨壁缺损的大小和形状；应用Medpor进行眼眶缺损修复和眼球内陷的复位。结果：在38例眼眶爆裂性骨折患者中，30例治愈，5例有明显的改善，3例有改善。结论：Medpor是理想的眶内充填材料，眼周瘢痕松解、眼轴线后的充填是眼球内陷复位手术成功的关键。     

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.     

眼眶爆裂性骨折的早期Medpor填充手术的疗效评估

目的：探讨眼眶爆裂性骨折早期Medpor填充治疗效果。方法回顾26例（26只眼）眼眶爆裂性骨折早期行手术患者的病例资料．观察患者手术前术后视力、眼球突出度、眼外肌运动及复视等情况。结果术后随访3-6个月,26例患者术后均未出现患眼明显视力下降．术后眼球内陷度数为（O．7±0.3）mm,与术前（3．1±0．8）mm相比,差异有统计学意义（P〈O．05）。术后3个月,26例患者复视完全消失,以上26例患者均未发现填充物移位、感染或排异反应。结论早期诊断、早期治疗及术后早期运动训练,是治疗效果的关键。Medpor填充治疗眼眶爆裂性骨折所致复视、眼球内陷,临床效果安全可靠。     

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3．5mm，术后均值1．5mm，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2mm，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。     

眼轴线后部眶容积增大与眼球内陷比值的测定研究

目的:通过测量眼眶爆裂性骨折伴有眼眶扩大患者的后部眼眶容积、观察眼球内陷出现的时间及程度,研究后部眶容积扩大与眼球内陷的关系比值,为病情预测和眶内填充手术提供比较精确的参考数据。方法:将96例患者按发病时间分为早期病例组(60例、受伤时间1周以内)和晚期病例组(36例、受伤时间3个月以上),早期组除进行后部眼眶容积测量外,分别于1周、2周、3周测定眼球突出度(相差>1mm为阳性),记录眼球内陷出现时间,用卡方检验进行统计学分析;晚期组测量后部眶容积增大值和眼球内陷量,对其相关性采用Pearson统计方法进行统计学分析,并得出回归方程及相关系数。结果:早期组60例患者中,(58.33%)例患者在1周内出现眼球内陷,4(880%)例在2周内出现内陷,3周时有5(388.33%)例呈现出内陷;2周时出现眼球内陷的例数与1周时有显著性差异(χ2=62.484,P<0.001),2周时出现眼球内陷例数与3周时无差异(χ2=1.563,P>0.05),1周时出现眼球内陷例数与3周时有显著差异(χ2=76.885,P<0.001),后部眶容积增大与眼球内陷的比值约为1.0,两者之间呈正相关(r=0.994,P<0.001),即后部眶容积每增加1ml,产生1.0mm的眼球内陷。结论:眼球内陷通常于伤后2周～3周出现,3个月时趋向稳定;后部眶容积增大与眼球内陷产生比值为1.0,呈正相关;后部眶容积扩大与眼球内陷比值可预测发生眼球内陷的可能性和程度,为手术矫正眼球内陷提供可靠、精确的参考,具有十分重要的临床指导意义。     

非单纯性眼眶骨折的手术治疗

目的回顾性分析总结手术治疗非单纯性眼眶骨折的临床经验。方法2010年1月至2017年12月,中国医科大学附属第一医院整形外科收治的587例眼眶骨折患者,男性455例,女性132例,年龄19~65岁。术前根据临床表现和3D-CT检查结果进行诊断和评估;术中充分松解还纳嵌顿的软组织、复位眼眶、放置置入体;术后比较眼眶外形、眼球功能及3D-CT等评价手术效果。结果本组587例,术后均获10个月至2年随访,所有患者术后外形和功能均得到整体的改善或恢复。12例术前眼球内陷明显,术后仍有轻度内陷;9例仍有轻度眼球运动受限、复视部分恢复;除眼球破裂摘除患者,其余患者视力较受伤前均无明显下降。结论眼眶骨折需严格依据临床表现和3D-CT检查结果进行诊断和评估,及早地进行精确复位、固定、修补,可提高治疗的效果。     

经泪阜入路修复眼眶内侧壁骨折后眼球内陷

目的探讨经泪阜人路修复眼眶内侧壁骨折后眼球内陷的手术方法和疗效。方法2004年9月至2010年3月,收治36例眼眶内侧壁骨折眼球内陷患者。根据术前眼眶水平位及冠状位CT检查,确认眶骨骨折及眶内容物移位情况。术中经泪阜人路修复眼眶内侧壁骨折后的眼球内陷。结果术后除5例改善不明显外,其余患者眼球内陷畸形均获明显改善,皮肤面不遗留手术切口瘢痕。术后患者均获随访,随访时间1年。结论经泪阜人路修复眼眶内侧壁骨折所致眼球内陷,比传统方法更加快捷,术后患者外形更美观。     

高密度多孔聚乙烯植入修复眶壁爆裂性骨折继发眼球内陷畸形

目的 探讨眶壁爆裂性骨折继发眼球内陷畸形的修复方法。方法1996年12月～2004年3月，共治疗眶壁爆裂性骨折继发眼球内陷患者56例，男30例，女26例。年龄22～48岁，平均32．5岁。受伤至手术时间16d～5年，合并复视患者34例，视力较受伤前降低者35例。采用下睑缘切口，于下眶缘骨膜下沿内下眶壁向眶尖方向潜行剥离。充分暴露骨折部位和松解嵌入上颌窦的眼眶组织并使其复位，使之成为骨膜下间隙。依据眼球的内陷程度，采用高密度多孔聚乙烯(porous high-density polyethylene，PHDPE)Medpor修复眶内下壁及其他眶壁缺损，矫正眼球内陷畸形。结果术后所有患者经2个月～5年随访，眼球内陷程度均稳定在2mm以内，无畸形复发及其他并发症发生。术后眼球内陷畸形均得到明显改善。34例复视患者中27例恢复，35例视力下降患者中9例视力较术前有不同程度改善，无复视加重和视力下降现象。大多数患者外观改善明显，其他患者也有不同程度改善，患者对手术效果满意。结论眶壁骨折整复术安全有效，手术应及早进行。Medpor组织相容性好、塑形容易、硬度适中、吸收率低、并发症少及手术效果稳定持久，是首选植人物。为防止眼球内陷畸形矫正不足，术中一般需矫正超过对侧1～2mm，严重的内陷者，术中矫正应超过2mm以上。     

眶骨折后内壁下壁容积扩大与眼球内陷的关系

目的通过对眶骨折后容积扩大量与眼球内陷值以及分别对眶内壁、眶下壁容积扩大量与眼球内陷值之间完成相关性研究,探讨对眼球内陷影响较大的变量,为临床诊断和治疗提供依据。方法对17例单侧眼眶骨折（内壁下壁联合骨折）继发晚期眼球内陷的患者行螺旋CT扫描（64排）,层厚0．625mm,以Dicom格式存储并输入Mimics软件,对眶容积、眼球突出度、眶内壁容积扩大量、眶下壁容积扩大量分别进行测量。对眼眶容积和眼球内陷值进行直线相关与回归分析,对眶内壁扩大量、眶下壁扩大量和眼球内陷值进行多元线性相关与回归分析。结果眼眶容积扩大量（V）和眼球内陷值（E）之间的直线回归方程：E=0．851—0．197（Pearson法,r=0．969,P〈0．01,回归系数95％的可信区间0．732~0．970）;眼球内陷值（E）与眶内壁容积扩大值（VM）、眶下壁容积扩大值（VF）之间的标准化多元回归方程：E=0．690VF＋0．413VM-0．086（Setpwise法,入选为0．5,剔除为0．1,P％0．01）;比较自变量的标准化回归系数,bF（0．690）〉bM（0．413）。结论眼眶骨折后眶容扩大量和眼球内陷值呈高度正相关,眼眶容积每扩大1ml,眼球内陷约0．8mm;眶下壁骨折容积扩大量对眼球内陷值的影响比眶内壁骨折容积扩大量大,前者是后者的1．56倍。     

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。     

Delayed immediate surgery for orbital floor fractures: Less can be more

Orbital floor fractures can result in diplopia, enophthalmos, hypoglobus and infraorbital dysthesia. Currently, the most common treatment for orbital floor fractures is immediate surgical intervention. However, there are a number of well-documented cases of unoperated orbital floor fractures in the literature, culminating in diplopia or enophthalmos in few patients. Of these, none reported the diplopia or enophthalmos to be bothersome. As reported previously in the ophthalmology literature, most orbital floor fracture-induced diplopia resolves as the swelling settles, and the few patients with remaining diplopia can successfully be treated with surgery on the uninvolved eye. It has also been commented that most patients with enophthalmos are asymptomatic. The authors’ institution has more than 50 surgeon-years experience with delaying immediate surgery for two weeks to allow time for the swelling-induced diplopia to resolve. In the authors’ experience, true entrapment of the inferior rectus muscle is rare. The present article describes a study of late follow-up (average 945 days) of 11 nonoperated patients with orbital floor fractures. In the eight patients who initially presented with diplopia, there was resolution of functionally limiting double vision. Only one patient had asymptomatic, but measurably significant, enophthalmos at −3 mm. All patients had full restoration of extraocular movements and resolution of infraorbital dysthesia. None of the patients were exposed to the operative risks of ectropion, infection, implant extrusion, bleeding or blindness. The present study provides level IV evidence that delaying surgery up to two weeks after orbital floor fracture may avoid unnecessary surgical risks and inconveniences in many patients with orbital floor fracture.     

Endoscopic repair of orbital floor fractures

Significant orbital trauma can result in orbital floor fractures with subsequent prolapse of the orbital contents into the paranasal sinuses. Prolapse of the periorbita can result in extraocular muscle entrapment, diplopia, enophthalmos, and even visual loss. Management of orbital floor fractures traditionally has been accomplished through transconjunctival and subciliary incisions. These approaches provide adequate visualization and cosmetically acceptable scars. Unfortunately, post-operative lid malposition can occur in a small percentage of cases. Another limitation is easy visibility of the posterior orbit, which often is obscured by prolapsed orbital fat. In light of these limitations, some surgeons have begun to evaluate an endoscopic approach to orbital floor fractures. The endoscopic approach offers a hidden incision, improved fracture visualization, and avoidance of post-operative eyelid malposition. This article reviews the indications, technique, and potential complications of endoscopic orbital blow-out fracture repair.     

Correction of posttraumatic enophthalmos

Management of posttraumatic enophthalmos can present as a challenge to the reconstructive surgeon, particularly in cases of late presentation. This article reviews the pertinent anatomy of the orbit, diagnostic modalities, indications for surgery, and surgical approaches as they relate to the treatment of posttraumatic enophthalmos. Internal orbital reconstruction has evolved to an elegant procedure incorporating various biologic or alloplastic implants, including anatomical pre-bent implants. Successful repair of late enophthalmos has been demonstrated in multiple recent studies and is likely related to the precision with which orbital anatomy can be restored.     

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.     

眼眶爆裂性骨折的早期和晚期整复手术疗效比较

目的研究眼眶爆裂性骨折早期和晚期整复手术疗效的差异.方法应用眼眶三维重建,CT扫描和复视分析方法,以Medpor为填充材料,对15例早期和16例晚期爆裂性骨折实施眼眶重建术,并进行术后疗效比较性研究.结果早期手术患者中复视8例,术后复视未消失1例.眼眶内陷15例均得到矫正,内陷均小于2 mm.眶下神经感觉减退10例,术后眶下神经感觉减退2例.晚期手术患者中术前复视10例,术后未消失7例,其中未改善4例,加重2例,5例行眼外肌手术矫正复视得到一定改善.眼眶内陷16例中术后未矫正3例,内陷大于2mm,再次手术2例.眶下神经感觉减退9例,术后未改善2例.经Fisher精确率检验两组患者术前和术后疗效比较中,只有复视矫正的差异有显著性(x2=4.865,P＜0.05).结论手术是治疗眼眶爆裂性骨折较好的方法,早期手术比晚期手术操作容易、效果好、恢复快、并发症少、再次手术机会少.     

Safety of titanium mesh for orbital reconstruction.

During the past several decades, the standard of care for orbital reconstruction after trauma has been autogenous bone grafts. Complications of bone grafts, including donor site morbidities such as scar alopecia and graft resorption with delayed enophthalmos, have inspired an interest in the use of alloplastic substitutes such as titanium. Titanium's role in orbital reconstruction was limited originally to small orbital defects, and as an adjunct to bone grafts. More recently, clinical studies have documented the sole use of titanium mesh to reconstruct large orbital defects. This study sought to document further the safety and efficacy of titanium mesh in reconstructing large orbital defects after facial trauma, with more extensive follow-up compared with previous studies. In the current study, 55 patients with 67 orbital fractures underwent orbital reconstruction with titanium mesh over a 5-year period. Associated fractures were reduced anatomically and fixed rigidly. For the analysis, 44 patients with 56 orbital fractures had adequate follow-up (mean, 44 months). An abscess developed in one patient who received high-dose steroids for 72 hours before reconstruction. She was treated with broad-spectrum intravenous antibiotics and bedside incision and drainage, and did not require removal of the titanium mesh. No patient in the current series required removal of the titanium mesh. A single case of uncorrected enophthalmos was treated with bone grafting rather than mesh revision. Large orbital defects can be reconstructed using titanium mesh with good functional results and minimal risk for infection. This study covered the authors' first 5 years using titanium. They have now used titanium mesh in orbital reconstructions for more than 10 years, without any additional cases of infection.     

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。