Department of Otolaryngology–Head and Neck Surgery, University of Washington, 1959 Pacific St NE, Seattle, WA 98195, USA.
JAMA Facial Plast Surg. 2013 Mar 1;15(2):113-20. doi: 10.1001/jamafacial.2013.316.
(1) To describe repair of complex orbital fractures using computer planning with preoperative virtual reconstruction, mirror image overlay, endoscopy, and surgical navigation. (2) To test the hypothesis that this technique improves outcomes in complex orbital fractures.
A series of 113 consecutive severe orbital fracture cases was analyzed, 56 of which were performed with mirror image overlay guidance, and 57 of which were repaired without. Data were collected on patient characteristics, fracture severity, diplopia and globe position outcomes, complications, and need for revision surgery.
The mirror image overlay group showed decreased postoperative diplopia in all fracture types (P = .003); the effectiveness was maximal for fractures that involved 3 or 4 walls or the posterior one-third of the orbital floor (P < .001). The need for revision surgery was greatly reduced in this cohort (4% vs 20%; P = .03).
The efficacy of mirror image overlay navigation and orbital endoscopy was studied in one of the largest series of complex orbital fractures in the literature. Based on statistically significant improved outcomes in postoperative diplopia and orbital volume, as well as the decreased need for revision surgery, we accept the hypothesis that mirror image overlay guidance improves outcomes in complex orbital reconstruction and recommend its use for complex orbital fracture repair.
（1）描述使用术前虚拟重建、镜像叠加、内窥镜和手术导航进行计算机规划修复复杂眼眶骨折的方法。（2）验证该技术是否能改善复杂眼眶骨折的治疗效果。
分析了 113 例连续严重眼眶骨折病例，其中 56 例采用镜像叠加引导，57 例未采用。收集患者特征、骨折严重程度、复视和眼球位置结果、并发症和需要再次手术的数据。
镜像叠加组在所有骨折类型中术后复视均减少（P =.003）；对于涉及 3 或 4 壁或眶底后 1/3 的骨折，效果最大（P <.001）。该组需要再次手术的人数大大减少（4%对 20%；P =.03）。
在文献中最大的复杂眼眶骨折系列之一中研究了镜像叠加导航和眼眶内窥镜的效果。基于术后复视和眶容积的统计学显著改善，以及再次手术需求的减少，我们接受镜像叠加引导改善复杂眼眶重建效果的假设，并建议将其用于复杂眼眶骨折修复。
