Balaji S M, Balaji Preetha
Director and Consultant, Oral and Craniomaxillofacial Surgeon, Balaji Dental and Craniofacial Hospital, Chennai, Tamil Nadu, India.
Ann Maxillofac Surg. 2019 Jan-Jun;9(1):129-134. doi: 10.4103/ams.ams_45_19.
The purpose of this study is to compare the association of diplopia after orbital fracture repair using titanium mesh and high-density polyethylene-coated titanium mesh.
Retrospective review of records of consecutive patients who presented for primary/secondary correction of orbital fracture attending author's institute was done. Patients attending the institution between January 2013 and December 2017 (5 years' period) fulfilling the inclusion and exclusion criteria were included for this study.
In all, 44 patients, who fulfilled the inclusion and exclusion criteria, were included in the study. The mean age was 31.86 ± 9.1 years and the mean period of follow-up was 9.37 ± 2.1 months postoperatively, with a range of 6.5-24 months. There were 65.91% males, and the most common etiology was road traffic accident (50%). In all, 11 (25%) cases had postoperative diplopia. Of the 11 cases that had diplopia, 6 had Class 1 and 5 had Class 2 diplopia. Of these 11 cases, 8 cases had completion or partial resolution of diplopia by the end of 8 weeks' period, and in 3 cases, it persisted even after 3 months of care. The occurrence of diplopia was compared by demographic factor using Chi-square test, and the mesh type was only statistically significant ( = 0.026).
The present study indicates that both types of mesh provide reliable, clinically better results. However, with passage of time, it was clinically observed that removing uncoated mesh poses extreme difficulty by the adherences and growth penetrating the meshes. In certain instances, clinically, it was observed that such adhesions may be a cause of compromise of eyeball movement.
Noncoated titanium orbital implants may lead to the adherence of orbital and periorbital structures, resulting in restrictive diplopia. High-density polyethylene-coated titanium mesh shows better performance as compared to noncoated mesh in preventing adherence situations.
本研究旨在比较使用钛网和高密度聚乙烯涂层钛网进行眼眶骨折修复术后复视的相关性。
对在作者所在机构接受眼眶骨折一期/二期矫正的连续患者的记录进行回顾性研究。纳入2013年1月至2017年12月（5年期间）在该机构就诊且符合纳入和排除标准的患者进行本研究。
共有44例符合纳入和排除标准的患者纳入研究。平均年龄为31.86±9.1岁，术后平均随访时间为9.37±2.1个月，范围为6.5 - 24个月。男性占65.91%，最常见的病因是道路交通事故（50%）。共有11例（25%）患者术后出现复视。在这11例复视患者中，6例为1级复视，5例为2级复视。在这11例患者中，8例在8周结束时复视完全或部分缓解，3例在经过3个月的治疗后复视仍持续存在。使用卡方检验按人口统计学因素比较复视的发生率，结果显示网片类型具有统计学意义（P = 0.026）。
本研究表明，两种类型的网片均能提供可靠的、临床上较好的效果。然而，随着时间的推移，临床观察发现，去除未涂层的网片因粘连和组织长入网孔而极具难度。在某些情况下，临床观察到这种粘连可能是眼球运动受限的一个原因。
未涂层的钛质眼眶植入物可能导致眼眶和眶周结构粘连，从而导致限制性复视。与未涂层的网片相比，高密度聚乙烯涂层钛网在预防粘连方面表现更佳。
