Huang Li, Lin Lisong, Wang Zhihong, Shi Bin, Zhu Xiaofeng, Qiu Yu, Huang Yue, Yu Xueyuan, Liao Yunyang
*Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital, Fujian Medical University; Research Institute of Facial Restoration and Reconstruction, Fujian Medical University †Department of Mathematics Physical and Computer Education, Fujian Medical University, Fuzhou, Fujian Province, China.
J Craniofac Surg. 2017 Jan;28(1):172-179. doi: 10.1097/SCS.0000000000003201.
The aim of the study was to precisely assess the severity of traumatic orbital defects and techniques for personalized orbital reconstruction.
A retrospective study was conducted in 97 patients with traumatic orbital defects who were treated in our hospital between July 2003 and June 2012. Pre- and postoperative spiral computed tomography scans were performed in all patients. A spatial orientation technique was used to measure the three-dimensional position of the globe and calculate the changes in the orbital volume. Subsequently, a computer-assisted technique and a rapid prototyping technique were used to create a personalized orbital model to aid in the planning of surgery as well as the preforming of implants and bone plates. During surgery, the herniated orbital contents were returned; the preformed titanium mesh, Medpor, or other implants were placed; the orbital shape in the defect site was precisely restored; and normal proportions between the orbital walls and orbital contents were regained. The treatment outcomes were evaluated with respect to postoperative appearance, patients' satisfaction, ophthalmologic examination, and computed tomography scan. The complications were analyzed accordingly.
Satisfactory results were achieved in all patients with the following exceptions: 1 patient with an unsatisfactory facial appearance; 2 patients with old trauma and an unfavorable correction of enophthalmos who experienced diplopia with no significant improvement within 6 months after surgery; and 2 patients of mild postoperative lower eyelid ectropion. All other patients achieved satisfactory treatment effects, that is, the orbital shape in the defect site was precisely restored, and normal proportions between the orbital walls and orbital contents were regained. There were no other severe complications reported.
In patients with traumatic orbital defects, accurate digital evaluations of the three-dimensional position of the globe and changes in the orbital volume aid in surgical planning with a personalized model and promote early surgery with minimal trauma. When the orbital volume was restored and the position of the globe was maintained or corrected, the precise reconstruction of the anatomic shape of the orbit was concurrently completed. Personalized orbital reconstruction can improve the efficacy of plastic surgery in patients with orbital deformities.
本研究旨在精确评估创伤性眼眶缺损的严重程度以及个性化眼眶重建技术。
对2003年7月至2012年6月期间在我院接受治疗的97例创伤性眼眶缺损患者进行回顾性研究。所有患者均进行了术前和术后螺旋计算机断层扫描。采用空间定位技术测量眼球的三维位置并计算眼眶容积的变化。随后，使用计算机辅助技术和快速成型技术创建个性化眼眶模型，以辅助手术规划以及植入物和骨板的制作。手术过程中，将脱出的眼眶内容物回纳；放置预制的钛网、Medpor或其他植入物；精确恢复缺损部位的眼眶形状，并恢复眼眶壁与眼眶内容物之间的正常比例。根据术后外观、患者满意度、眼科检查和计算机断层扫描评估治疗效果，并相应分析并发症。
除以下情况外，所有患者均取得满意结果：1例面部外观不满意；2例陈旧性创伤且眼球内陷矫正效果不佳的患者，术后出现复视，术后6个月内无明显改善；2例术后轻度下睑外翻。所有其他患者均取得满意的治疗效果，即缺损部位的眼眶形状得到精确恢复，眼眶壁与眼眶内容物之间恢复正常比例。未报告其他严重并发症。
对于创伤性眼眶缺损患者，对眼球三维位置和眼眶容积变化进行准确的数字评估有助于使用个性化模型进行手术规划，并促进创伤最小化的早期手术。当眼眶容积恢复且眼球位置得以维持或矫正时，同时完成眼眶解剖形状的精确重建。个性化眼眶重建可提高眼眶畸形患者整形手术的疗效。
