Azzi Jayson, Azzi Alain Joe, Cugno Sabrina
Faculty of Medicine, University of Ottawa, Canada.
Division of Plastic and Reconstructive Surgery, Montreal Children's Hospital, McGill University, Montreal.
J Craniofac Surg. 2018 Oct;29(7):1693-1696. doi: 10.1097/SCS.0000000000004630.
The use of resorbable materials is becoming more popular for pediatric orbital floor reconstruction. The purpose of this systematic review is to evaluate the effectiveness and safety of the various materials used in pediatric orbital floor reconstruction.
A systematic literature search was performed to identify all relevant articles reporting complications following pediatric orbital floor reconstruction. The search included published articles in three electronic databases-Ovid MEDLINE, EMBASE, and PubMed starting from database establishment to July 2017. Primary endpoints were enophthalmos, diplopia, and infection. Resorbable material was compared to autologous grafts and nonresorbable material.
A total of 14 studies containing 248 patients were included in this review. Fifty-four (21.8%) patients had reconstruction performed with autologous grafts, 72 (29.0%) patients with resorbable material, and 122 (49.2%) patients with nonresorbable material. Resorbable materials had the lowest rate of postoperative enophthalmos (3/52; 5.8%) and the highest rate of postoperative diplopia (19/72; 26.4%). In contrast, nonresorbable materials had the lowest rate of postoperative diplopia (5/122; 4.1%), the highest rate of postoperative enophthalmos (14/102; 13.7%). Autologous reconstruction was associated with an 11.1% (4/36) rate of postoperative enophthalmos and a 22.2% (12/54) rate of postoperative diplopia. Nine cases (8.8%) of postoperative infection were documented with nonresorbable materials. No cases of infection were reported with autologous grafts or resorbable materials.
Newer resorbable implants are safe and have a similar complication profile as traditional autologous grafts in pediatric orbital floor reconstruction.
可吸收材料在小儿眶底重建中的应用越来越普遍。本系统评价的目的是评估小儿眶底重建中使用的各种材料的有效性和安全性。
进行系统的文献检索,以确定所有报告小儿眶底重建后并发症的相关文章。检索包括从数据库建立到2017年7月在三个电子数据库(Ovid MEDLINE、EMBASE和PubMed)中发表的文章。主要终点是眼球内陷、复视和感染。将可吸收材料与自体移植物和不可吸收材料进行比较。
本评价共纳入14项研究,涉及248例患者。54例(21.8%)患者采用自体移植物进行重建,72例(29.0%)患者采用可吸收材料,122例(49.2%)患者采用不可吸收材料。可吸收材料术后眼球内陷发生率最低(3/52;5.8%),术后复视发生率最高(19/72;26.4%)。相比之下,不可吸收材料术后复视发生率最低(5/122;4.1%),术后眼球内陷发生率最高(14/102;13.7%)。自体重建术后眼球内陷发生率为11.1%(4/36),术后复视发生率为22.2%(12/54)。不可吸收材料记录到9例(8.8%)术后感染。自体移植物或可吸收材料未报告感染病例。
新型可吸收植入物在小儿眶底重建中是安全的,并发症情况与传统自体移植物相似。