Zhu Z, Stevens M R, Wu H
Department of Stomatology, Second Affiliated Hospital of Hunan Medical University, Changsha 410011, China.
Zhonghua Zheng Xing Wai Ke Za Zhi. 2001 Sep;17(5):294-6.
To evaluate the effects of autogenous calvarial bone grafts on treatment of the patients with defect of orbital floor from facial trauma.
During a 5-year period from April 1994 to April 1999, 34 patients ranging in age from 16 to 68 years (twenty males and fourteen females), who presented with orbital floor defects associated with other facial fractures were reconstructed by autogenous calvarial bone grafts. The surgical approach to the orbital floor involved a transconjunctival incision in 31 patients and a subciliary incision in 3 patients. After the orbital floor exploration, the bone graft was harvested through the coronal incision in 29 patients and the parietotemporal region incision in 5 patients. The bone graft was then fashioned to the appropriate size and configuration and fixed to the stable bone of the orbital floor with microplates or screws.
The surgical incisions healed well with a minimal scar. There were no infection, extrusion or other complications associated with autogenous calvarial bone graft. There were no cases of optic neuropathy, diplopia and enophthalmos. There was no morbidity in donor sites. One patient had slight ectropion, which lasted three months and became inconspicuous in six months. 8 cases with hypoesthesia of the infraorbital region returned the sensory function within 6 months. 6 patients with enophthalmos were partly corrected. The follow-up period ranged from 6 months to 5 years.
The orbital floor defects should be managed by early exploration to avoid later complications. The sequel, such as enophthalmos and dystopia or diplopia are much more difficult to correct after bony union. A vast array of autogenous and alloplastic materials have been used to reconstruct the defect of orbital floor. Autogenous bone graft reduces the risk of infection and extrusion. Cranial bone graft produces less donor site morbidity compared with other sites, non-visible scar as the incision is placed within the hair-bearing skin and the conjunctiva. The membranous bone from the skull has been shown to undergo less resorption and greater graft volume survival as compared to endochondral bone of the iliac crest or rib. Skull bone is an ideal source of bone graft in orbital reconstruction.
评估自体颅骨骨移植治疗面部创伤所致眶底缺损患者的效果。
在1994年4月至1999年4月的5年期间，对34例年龄在16至68岁之间（男性20例，女性14例）、伴有其他面部骨折的眶底缺损患者采用自体颅骨骨移植进行重建。眶底手术入路中，31例采用经结膜切口，3例采用睑缘下切口。眶底探查后，29例患者通过冠状切口获取骨移植材料，5例通过顶颞区切口获取。然后将骨移植材料修整成合适的大小和形状，并用微型钢板或螺钉固定于眶底稳定的骨面上。
手术切口愈合良好，瘢痕极小。未发生与自体颅骨骨移植相关的感染、排斥或其他并发症。未出现视神经病变、复视和眼球内陷病例。供区无并发症。1例患者出现轻度睑外翻，持续3个月，6个月后不明显。8例眶下区感觉减退患者在6个月内恢复感觉功能。6例眼球内陷患者得到部分矫正。随访时间为6个月至5年。
眶底缺损应尽早探查处理，以避免后期并发症。骨愈合后，如眼球内陷、移位或复视等后遗症更难纠正。大量自体和异体材料已用于重建眶底缺损。自体骨移植可降低感染和排斥风险。与其他部位相比，颅骨骨移植供区并发症更少，由于切口位于有毛发的皮肤和结膜内，瘢痕不可见。与髂嵴或肋骨的软骨内骨相比，颅骨的膜性骨吸收较少，移植体积存活更多。颅骨是眶重建中理想的骨移植来源。
