Department of Plastic and Reconstructive Surgery, College of Medicine, Catholic University of Korea, Seoul, Korea.
Department of Mechanical Engineering, Korea Polytechnic University, Siheung, Korea.
J Anat. 2020 May;236(5):923-930. doi: 10.1111/joa.13136. Epub 2019 Dec 18.
The inferomedial orbital strut (IOS) is the thin bony junction of the orbital medial wall and floor. Its fracture is common and leads to serious complications, including enophthalmos, globe dystopia and diplopia. However, anatomical restoration of the IOS is challenging owing to reduced structural support; sound anatomical background and accurate implants are therefore essential. The aim of the present study was to incorporate data from cadaveric orbit anatomy into three-dimensional (3D) printing technology and to reconstruct the complex orbital fracture elaborately. After averaging the data from computed tomography (CT) images of 100 adult cadavers, the dimensions of the IOS were extracted, and a tangent sphere was created using a computer-aided design program. The curves were compared with the CT data of 10 adult patients from the simulation test. Based on these data, a standardized 3D implant, 1.15 mm thick, was designed using polycaprolactone. The implant was placed in five patients with complex orbital fractures. The radius of the sphere in contact with the orbit, measuring 33.54 mm, was confirmed to be appropriate. A comparison between the normal side volume (V0) and the postoperative volume (V ) showed that they were statistically similar. Furthermore, a comparison between V0 and the preoperative volume (V ), and V compared with V also showed a statistically significant difference (P < 0.05). On follow-up, the preoperative ocular symptoms were resolved. The orbital data obtained from 100 cadavers provided standardized orbital anatomy, and 3D printed implants were created. The implants were anatomically accurate with regard to the orbital cavity and adequately covered the simulation model. The implant also showed satisfactory results when applied clinically in actual patients.
内侧眶下支柱（IOS）是眼眶内侧壁和地板的薄骨连接。它的骨折很常见，会导致严重的并发症，包括眼球内陷、眼球异位和复视。然而，由于结构支撑减少，IOS 的解剖复位具有挑战性；因此，良好的解剖背景和准确的植入物是必不可少的。本研究旨在将尸体眼眶解剖学数据纳入三维（3D）打印技术，并精心重建复杂的眼眶骨折。在对 100 具成人尸体的 CT 图像数据进行平均后，提取了 IOS 的尺寸，并使用计算机辅助设计程序创建了一个切向球体。将曲线与 10 名成人患者的 CT 数据进行模拟测试比较。基于这些数据，使用聚己内酯设计了一种标准化的 3D 植入物，厚度为 1.15 毫米。将植入物放置在 5 例复杂眼眶骨折患者中。与眼眶接触的球体半径为 33.54 毫米，被证实是合适的。对正常侧体积（V0）和术后体积（V）的比较表明，两者在统计学上相似。此外，V0 与术前体积（V1）的比较，以及 V 与 V 的比较也显示出统计学上的显著差异（P<0.05）。随访时，术前眼部症状得到缓解。从 100 具尸体获得的眼眶数据提供了标准化的眼眶解剖结构，并创建了 3D 打印植入物。植入物在解剖学上与眼眶腔相符，并且充分覆盖了模拟模型。当在实际患者中进行临床应用时，植入物也显示出令人满意的结果。
