计算机辅助测量颧眶骨折术前后眼眶容积的临床意义

目的:通过测量颧眶骨折术前术后眼眶容积的变化,得出术后可能仍然出现眼球内陷的术前眼眶容积大小。方法:20例颧眶骨折患者在术前及行坚固内固定术后,分别做多排三维螺旋CT(MSCT)扫描,利用Simplant软件测量眼眶容积进行比较,并做统计学分析。结果:术前20例患者均存在眼眶容积的增大,与健侧眼眶容积相比增大范围为0.07～7.50cm3。术前两侧眼眶容积差值的平均值为(3.06±1.96)cm3,术后差值减少到(0.93±1.00)cm3,术前术后眼眶容积存在显著差异(P<0.01)。10例患者术后仍然存在不同程度的眼球内陷,其术前眼眶容积差值为(4.60±1.27)cm3。结论:眼眶容积测定有助于术者制定手术方案,恢复应有的眼眶容积。     

颧眶骨折合并眼球内陷的治疗

目的：总结颧眶骨折合并眼球内陷的整复方法。方法：采用头皮冠状切口等入路,将骨折断端显露、复位、固定,回纳嵌顿的眶内软组织,颅骨外板或Medpor修复缺损。结果：7例患者经治疗,眼球内陷均得以矫正,颧部外形得以改善。结论：重建眼眶的特殊解剖结构是手术关键,术中还应对眼球内陷过矫正。     

眼眶骨折重建和眼球内陷矫治的现状与展望

眼眶骨折重建涉及眼科、口腔科、神经外科、耳鼻喉科等多个学科和领域,是最复杂的眼眶外科手术之一。随着工业外伤和交通事故的发生率增加,眼眶骨折患者也越来越多。随着口腔颌面外科、影像诊断和计算机图像处理技术的进步,我国的口腔颌面外科医师对眼眶骨折所导致的面部畸形及对视功能的损害已经有了较充分的认识。     

个性化钛网联合多孔高密度聚乙烯矫正眼眶骨折伴眼球内陷畸形

目的 应用镜像与快速成型技术制作个性化钛网重建眼眶,在钛网上植入多孔高密度聚乙烯（Medpor）矫正眼球内陷,评价其治疗效果。方法 对18例眼眶骨折患者术前行眼眶轴位、冠状位及矢状位CT扫描及三维重建,以CT数据为基础,应用快速成型技术制备实体模型,在其上制作个性化预成形钛网,术中植入钛网行眼眶重建,并在钛网基础上充填Medpor矫正眼球内陷。术后复查眼眶CT,检查钛网植入位置、眼及面部外形和眼功能。结果术后复查CT,18例患者的个性化预成形钛网均能精确地重建骨折的眼眶,眼及面部外形和眼功能显著恢复。术中术后均未发生严重并发症。结论 基于镜像与快速成型技术的个性化预成形钛网技术可以精确地重建骨折及伴有骨缺损的眼眶,在钛网上植入Medpor可有效矫正眼球内陷及眼球下移畸形。     

眼眶骨折的重建和眼球内陷的外科矫治

本文结合文献综述和作者的临床研究概括阐述了眼眶骨折的早期手术适应证、术前常规检查和CT诊断;介绍了眼眶骨折继发眼球内陷的发生机理和相关研究;描述了解剖重建眼眶、定量矫治眼球内陷的技术方法和发展动态。     

预成钛网在伴发眼球破裂眼眶骨折眶壁重建中的应用

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。     

计算机辅助技术测量眼眶容积的实验研究

目的:提出一个基于螺旋CT测量眼眶容积简单有效的方法,验证Simplant软件测量眼眶容积的准确性.方法:选用5个头颅骨骼标本进行螺旋CT扫描,数据以DICOM格式刻录存盘,用Simplant软件读取数据,并进行眼眶容积测量,同时用量筒法测量眼眶容积.采用SAS6.12软件包对数据进行配对t检验,验证该方法的可靠性.结果:Simplant软件测得平均眼眶容积为(28.81±1.65)ml,量筒法为(28.82±1.65)ml,两者无显著差异(P=0.987).2种方法相关分析,r=0.971,P<0.001,具有显著相关性.结论:Simplant软件测量眼眶容积是一种简单准确的方法.     

眼球突度和眼眶容积比的实验研究

目的：通过Hertel眼球突度测量计测量新鲜尸体上眼球突度与眼眶容积的变化,得到两者之间的直线关系。方法：选择新鲜尸体5具共10侧眼眶,将气管插管的气囊部分置入眶底与眶骨膜之间,用注射器注入7ml生理盐水,每抽出1ml生理盐水后,用Hertel眼球突度测量计测量眼球突度,共得到80个数据,采用SAS6.12软件包进行统计学分析。结果：眼球突度与眼眶容积之间呈线性相关关系,Y=8.57-0.96X（r=-0.86,P=0.0001≤0.05）。结论：气管插管球囊是一种测量眼眶容积变化的有效实验工具。新鲜尸体上眼球突度与眼眶容积增量之间存在直线相关关系。     

眼眶骨折标准诊断CT层面的确定与应用研究

目的:确定跟眶骨折的CT标准诊断层面,描述CT标准层面上的眼眶形态.方法:42侧正常眼眶和21例单侧骨折眼眶,摄取CT数据,输入图像软件.在设定的CT标准诊断层面上描述眶底、眶内壁、两者交界区的形态特征.与手术所见对照,评价眼眶骨折在标准层而的检出率.结果:设定9个标准层面.在4个矢状层面上,眶底形态靠外侧呈Ⅰ型,靠内侧呈Ⅱ型.圆孔层面眶底最深[男性(36.26±4.72)mm,女性(34.81±4.76)mm].在3个冠状层面上,眶内下壁交角由前向后逐渐增大,男性分别为(128.33±19.11)°、(132.57±22.17)°和(137.44±20.87)°,女性分别为(129.55±22.32)°、(134.95±25.50)°和(139.46±22.80)°.在轴位层面上,眶内/外缘到视神经管内口内/外壁距离男性分别为(38.47±4.41)mm和(47.13±4.10)mm,女性分别为(38.21±5.63)mm和(45.79±5.41)mm.冠状层面的眶底和眶内壁骨折检出率93.75%～100%,9个层面的总检出率为100%.结论:提出的9个CT标准层面可作为眼眶骨折的常规诊断层面.     

基于眼球三维空间精确定位测量的外伤性眼眶缺损的个体化重建

目的：探讨外伤性眼眶缺损损伤程度的精确评估以及个体化重建方法。方法：对2003年7月—2012年6月间收治的 97例外伤性眼眶缺损患者进行回顾性研究,患者手术前、后均进行螺旋CT扫描,采用眼球空间定位方法测量眼球的三维位置,计算眶容积的变化量,利用计算机辅助技术和快速原型技术制作个体化眶模型,进行模型外科,制订手术方案,并预制植入物和接骨板等。术中回纳疝出的眶内容物,植入预制的钛网、Medpor或其他植入物,精确重建缺损区的眶外形,恢复正常的眶和眶内容物的比例关系。根据术后外形、患者满意度、眼功能检查及CT检查结果评估疗效,分析并发症。结果：除1例患者面部外形欠满意,2例陈旧性患者眼球内陷矫正不佳,术后6个月复视仍无明显改善,2例术后轻度下睑外翻外,其余病例均取得满意疗效。缺损区的眶外形、眶及内容物的比例关系恢复满意,未发生明显并发症。结论：对外伤性眼眶缺损患者进行眼球三维空间位置、眶容积变化等损伤程度的精确数字化评估,通过个体化模型外科制定手术方案,早期手术,减少创伤,在恢复眶容积、维持和纠正眼球位置的同时精确重建眶壁解剖外形,可实现眶缺损个体化的重建,提高眶畸形整复效果。     

A computer-based method for calculation of orbital floor fractures from coronal computed tomography scans

PURPOSE: A computer program recently developed for the calculation of the orbital floor and fracture areas from coronal computed tomography (CT) scans was used in a study to evaluate the accuracy and ability of this new method. MATERIAL AND METHODS: The size of orbital floors and fabricated fractures in 14 dried, anatomic specimens were measured in coronal CT scans by 3 independent observers. Based on this data set, the orbital floor and fracture regions were calculated with the newly developed computer program. These calculated regions were then compared with a direct measurement of the specimens that had been obtained by digital photography. The accuracy of the computer-based calculations was assessed using Lin's concordance correlation coefficient. RESULTS: The size of the orbital floor (mean +/- SD) was found to be 5.21 +/- 0.39 cm(2) by direct measurement of the specimens and 5.30 +/- 0.52 cm(2) by calculation with the computer program. The region of the fracture (mean +/- SD) was 1.05 +/- 0.64 cm(2) by direct measurement and 1.01 +/- 0.62 cm(2) by computer calculation. The between-method mean difference (direct measurement minus computer based calculation) was -0.09 cm(2) (or 1.7% of mean orbital floor region) for orbital floor region and 0.04 cm(2) (or 3.8% of mean fracture region) for fracture region. CONCLUSIONS: This accurate and time-saving method is practicable for determining the size and location of orbital floor fractures. This calculation program can be advantageously applied in the clinical management of blowout fractures of the orbit.     

Radiographic volumetric risk factors for late enophthalmos prediction in orbital blow-out fractures: A retrospective study

The aim of this study was to assess the correlation between volumetric risk factors, orbital volume (OV), orbital volume ratio (OVR), herniated volume (HV), and the newly described herniated volume ratio (HVR), with the occurrence of late enophthalmos.Patients presenting a unilateral unoperated blow-out fracture were retrospectively included. OV and HV were measured using planimetry on the initial CT scan images. OVR and HVR were then calculated. Enophthalmos was measured on the 2-month follow-up CT scan images. The population was divided into two groups according to their enophthalmos status. Correlations and multiple linear regression model were used.17 patients out of 45 presented a late enophthalmos of 1 mm or more. There were significantly higher OVR (107 (3.76); p < 0.0001), HV (0.8 (0.47); p < 0.0001) and HVR (3.3 (1.82); p < 0.0001) in the enophthalmos group. A very strong linear correlation between enophthalmos and OVR (r_s = 0.806), HV (r_s = 0.948) and HVR (r_s = 0.951) was found.Enophthalmos prediction using these volumetric parameters can help the surgeon's decision-making in orbital blow-out fractures in order to prevent late enophthalmos. Measurement is simple and reproducible. However, larger prospective studies are needed to confirm these results.     

Correlation between increased orbital volume and enophthalmos and diplopia in patients with fractures of the orbital floor or the medial orbital wall

Fractures of the orbital floor and medial orbital wall (blowout fractures) are common midface injuries. Diagnostic methods and treatment options have improved over recent years, due to threedimensional image processing and the use of patient-specific implants. Nonetheless, the indications for orbital reconstructive surgery are still controversial. Previous authors have reported a linear correlation between post-traumatic increases in orbital volume and enophthalmos and diplopia. Post-traumatic increases in orbital volume are often considered to be predictive of long-term symptoms; therefore, it is commonly recommended that orbital volume increases be treated as an indication for early reconstructive surgery. However, the results of this study did not show any statistically significant long-term linear correlation between increased orbital volume and enophthalmos or diplopia, and the performance of orbital volume as a predictor of ocular symptoms was poor. Hence, we do not consider increased post-traumatic orbital volume to be particularly useful for predicting late enophthalmos or diplopia. However, a statistical correlation between fractures of the anterior and medial thirds of the orbital floor and double vision was found. As such, fractures of the middle and anterior third should be regarded as problematic, and surgical reconstruction should be considered in these cases.     

A comparison of imaging techniques with surgical experience in orbital injuries: A prospective study

The aim of the study is to compare the effectiveness of computerised tomography (CT) and magnetic resonance (MR) imaging in diagnosing herniation and entrapment of orbital soft tissues in orbital fractures. 15 consecutive patients with clinical signs and symptoms of medial orbital wall injury were examined with CT and MR. The data were subsequently compared with the findings of the surgical exploration with regard to the extent of the wall fractures, the presence of soft tissue herniation and its entrapment. CT and MR were equally accurate in demonstrating or excluding orbital wall fractures but both modalities slightly underestimated their incidence. CT and MR underestimated the actual incidence of soft tissue herniation and entrapment when compared with the surgical findings but the extent of soft tissue herniation and entrapment were demonstrated more clearly by MR than by CT scanning. MR imaging when available should therefore be used as the initial imaging modality and CT held in reserve for confirmation as positioning in the MR unit is easier and more comfortable for recently injured patients who may well have other injuries.     

CT血管造影在腓肠内侧动脉穿支皮瓣血管定位中的应用

目的 探讨运用CT血管造影（CTA）技术定位腓肠内侧动脉穿支的精确性,基于CTA定位下了解腓肠内侧动脉穿支皮瓣的解剖学特征。方法 选取9例舌癌患者,术前利用CTA技术对腓肠内侧动脉穿支进行定位,术中测量腓肠内侧动脉穿支皮瓣的相关解剖数据,测量穿支数量、皮肤穿出点位置、血管蒂长度及皮瓣厚度,运用SPSS 20.0软件包进行配对t检验,与术前CTA测量结果进行比较。结果 腓肠内侧动脉穿支皮瓣血管蒂长,管径与颈部血管匹配,对供区损伤小,CTA定位的血管蒂长度、皮瓣厚度以及血管穿支到坐标原点的距离与术中测量数据进行对比,均无显著差异;术前CTA定位测量准确。结论 术前运用CTA可精确定位穿支位置,利于皮瓣制备,减少手术风险和并发症。     

三维CT影像在颌骨骨折诊断与治疗中的临床价值

目的 :探讨三维CT影像在颌面部骨折中的诊断价值。方法 :对 17例颌骨骨折的三维CT影像及二维CT影像进行观察 ,分析其各自的特征并进行比较。结果 :三维CT影像在显示骨折的空间位置方面 ,如骨折线的行走路线 ,骨折片的移位距离与方向等都有独到的优势 ,但在显示上窦前壁线型骨折 ,骨折断端周围的软组织改变等方面不如二维CT影像。结论 :三维CT影像在显示颌面骨折处的空间关系上有很大的诊断意义及治疗指导意义 ,可以弥补二维CT影像的不足 ,但不能取代二维CT影像。     

根据CT扫描数据及印模三维重建牙列数字模型精度的初步研究

目的:评价根据CT扫描数据和牙列印模重建牙列数字模型的精度.方法:以OKIO-V-100三维光学扫描系统扫描猴牙列标本获取标准模型;根据螺旋CT、锥柬CT扫描数据重建颌骨及牙列三维数字模型;制取猴牙列标本印模,灌制石膏模型,通过OKIO-V-100三维光学扫描系统扫描重建牙列形态.分别将CT扫描重建的数字图像、石膏模型...