Timoshchuk Mari-Alina, Murnan Eric J, Chapple Andrew G, Christensen Brian J
Resident, Department of Oral & Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA.
Former Resident, Department of Oral & Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA.
J Oral Maxillofac Surg. 2022 Apr;80(4):669-675. doi: 10.1016/j.joms.2021.12.006. Epub 2021 Dec 21.
Patient-specific titanium implants are increasingly used in orbital trauma as a means of achieving improved surgical outcomes as well as decreasing postoperative complications; however, the data to support their use remain limited. The purpose of this study is to compare the complication rates and accuracy of orbital reconstruction using preformed titanium mesh implants and patient-specific implants.
The authors conducted a retrospective cohort study consisting of patients with orbital floor and/or medial wall fractures treated by reconstruction with either preformed or patient-specific implants from August 1, 2015 to December 31, 2020. The primary predictor variable was the implant type. Outcome variables were the percent volume difference between the reconstructed and uninjured orbital volume and complications. Statistical analysis was performed using Fisher exact test and Wilcoxon rank-sum test.
Of the 85 patients in the study, 73% were male and the average age was 38.7 ± 16.6 years. Sixty-one patients (72%) were treated with preformed implants and 24 (28%) with patient-specific implants. Complications occurred in 8.3% of the patient-specific implant group and 26.2% of the preformed implant group (P = .08). Percent volume difference between the reconstructed and nontraumatized orbit was 4.2% and 6.8% in the patient-specific and preformed implant group, respectively (P = .03).
Patient-specific implants improved orbital volume reconstruction accuracy but did not decrease complications when compared to preformed implants.
针对患者定制的钛植入物在眼眶创伤中使用得越来越多，以此来改善手术效果并减少术后并发症；然而，支持其使用的数据仍然有限。本研究的目的是比较使用预制钛网植入物和针对患者定制的植入物进行眼眶重建的并发症发生率和准确性。
作者进行了一项回顾性队列研究，研究对象为2015年8月1日至2020年12月31日期间接受预制或针对患者定制的植入物重建治疗的眶底和/或内侧壁骨折患者。主要预测变量为植入物类型。结果变量为重建眼眶体积与未受伤眼眶体积之间的体积差异百分比及并发症。采用Fisher精确检验和Wilcoxon秩和检验进行统计分析。
本研究的85例患者中，73%为男性，平均年龄为38.7±16.6岁。61例患者（72%）接受了预制植入物治疗，24例（28%）接受了针对患者定制的植入物治疗。针对患者定制的植入物组并发症发生率为8.3%，预制植入物组为26.2%（P = 0.08）。针对患者定制的植入物组和预制植入物组重建眼眶与未受伤眼眶之间的体积差异百分比分别为4.2%和6.8%（P = 0.03）。
与预制植入物相比，针对患者定制的植入物提高了眼眶体积重建的准确性，但并未降低并发症发生率。
