[单侧眼眶骨折眼眶壁重建导航系统的评估]

[Evaluation of the navigation system for orbital wall reconstruction in unilateral orbital fractures].

作者信息

Zhang Zhi-Yong, Feng Zhi-Qiang, Gong Xi, He Yang, An Jin-Gang, Zhang Yi

机构信息

Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.

出版信息

Zhonghua Kou Qiang Yi Xue Za Zhi. 2012 Nov;47(11):657-61. doi: 10.3760/cma.j.issn.1002-0098.2012.11.004.

DOI:10.3760/cma.j.issn.1002-0098.2012.11.004

PMID:23302425

Abstract

OBJECTIVE

To evaluate the efficiency of navigation system for orbital wall reconstruction in unilateral orbital fractures.

METHODS

Fifteen patients (7 male and 8 female) with unilateral orbital fracture underwent orbital reconstruction with the help of intraoperative navigation system. The average age was 34.3 ± 9.5 years. All patients underwent spiral CT scanning preoperatively, and the CT data was imported to the BrainLab navigation system (Germany, BrainLab company). The orbit of the intact side was mirrored to the opposite side as the reference for pre-operative planning. The titanium mesh was mounted on the resin template made by rapid prototyping machine based on the mirrored CT data. When the injury was limited, the hydroxyapatite sheet was used for the orbital wall reconstruction. During the operation, the real-time navigation helped to ensure precise placement. The re-establishing result was assessed based on the postoperative CT data with the following four variables: the volumetric difference between the bilateral orbit, the volume of the herniated soft tissue, the global projection and the discrepancy between the simulated and the achieved position of the reconstructed orbital wall. The reconstructive discrepancy was measured only in the titanium plate grafting cases.

RESULTS

There were no serious complications such as infection, graft rejection and optic nerve injury in any case. Preoperatively, the average degree of enophthalmos was (3.5 ± 1.6) mm, the average volumetric difference between the injured and the unaffected orbit was (4.5 ± 1.8) ml, and the average volume of the herniated orbital soft tissue was (2.1 ± 0.7) ml. Postoperatively, the three values were respectively reduced to (1.3 ± 0.6) mm, (1.8 ± 0.9) ml and (0.7 ± 0.3) ml. The discrepancy of the medial and inferior wall were (2.5 ± 0.6) mm and (2.1 ± 0.4) mm.

CONCLUSIONS

The intraoperative use of navigation system for the orbital wall reconstruction in unilateral orbital fractures can provide reliable accuracy and achieve satisfactory results.

摘要

目的

评估导航系统在单侧眼眶骨折眶壁重建中的有效性。

方法

15例单侧眼眶骨折患者（7例男性，8例女性）在术中导航系统辅助下进行眼眶重建。平均年龄为34.3±9.5岁。所有患者术前均行螺旋CT扫描，并将CT数据导入德国BrainLab公司的BrainLab导航系统。将健侧眼眶镜像至患侧作为术前规划的参考。根据镜像后的CT数据，将钛网安装在快速成型机制作的树脂模板上。当损伤局限时，使用羟基磷灰石片进行眶壁重建。术中，实时导航有助于确保精确放置。根据术后CT数据评估重建结果，包括以下四个变量：双侧眼眶容积差、疝出软组织体积、整体投影以及重建眶壁模拟位置与实际位置的差异。仅在钛板植入病例中测量重建差异。

结果

所有病例均未出现感染、移植排斥及视神经损伤等严重并发症。术前，平均眼球内陷程度为（3.5±1.6）mm，患侧与健侧眼眶平均容积差为（4.5±1.8）ml，眶内软组织平均疝出体积为（2.1±0.7）ml。术后，这三个值分别降至（1.3±0.6）mm、（1.8±0.9）ml和（0.7±0.3）ml。内侧壁和下壁的差异分别为（2.5±0.6）mm和（2.1±0.4）mm。