Kohyama Keishi, Ishihara Takuma, Tsuboi Yoshiki, Morishima Yoko
From the Department of Plastic and Reconstructive Surgery, Ogaki Municipal Hospital; and Gifu University Hospital Innovative and Clinical Research Promotion Center, Gifu University.
Plast Reconstr Surg. 2022 Oct 1;150(4):865-875. doi: 10.1097/PRS.0000000000009554. Epub 2022 Jul 29.
Despite the popularity and superiority of resorbable alloplastic materials in orbital fracture reconstruction, it is unclear whether the reconstructed wall is maintained after implant resorption. Unsintered hydroxyapatite/poly-L-lactide (u-HA/PLLA) is one such material, but it differs from conventional materials for the replacement of natural bones. This study investigated the intermediate-term safety and efficacy of u-HA/PLLA implants compared with those of implants made with other alloplastic materials.
The authors retrospectively analyzed 240 eligible patients who underwent orbital fracture reconstruction with one alloplastic material between January of 2006 and October of 2018. Materials used for treatment were as follows: u-HA/PLLA sheet in 101 patients, u-HA/PLLA mesh in 38 patients, poly-L-lactic acid/poly-glycolic acid mesh in 47 patients, silicone sheet in 35 patients, and titanium mesh in 19 patients. Intermediate-term follow-up was performed for a median duration of 48.2 months. A chart review was performed. Postoperative complications and factors affecting them were studied. Reconstructed area deformities were assessed using computed tomography.
Postoperative complications occurred significantly more frequently in patients reconstructed with the silicone sheet than in those reconstructed with the u-HA/PLLA sheet. Deformities were found for the silicone sheet (28.6 percent) and poly-L-lactic acid/poly-glycolic acid mesh (31.9 percent). These deformity rates were significantly higher than those for the u-HA/PLLA sheet.
Compared with other alloplastic materials, u-HA/PLLA has low rates of postoperative complications and reconstructed area deformities. Because of its complete absorption, clinicians should consider using u-HA/PLLA as an alloplastic material for orbital wall reconstruction.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
尽管可吸收异质材料在眼眶骨折重建中很受欢迎且具有优越性，但植入物吸收后重建的眼眶壁是否能维持尚不清楚。未烧结羟基磷灰石/聚-L-乳酸（u-HA/PLLA）就是这样一种材料，但它与用于替代天然骨的传统材料不同。本研究调查了u-HA/PLLA植入物与其他异质材料植入物相比的中期安全性和有效性。
作者回顾性分析了2006年1月至2018年10月期间接受一种异质材料眼眶骨折重建的240例符合条件的患者。治疗所用材料如下：101例患者使用u-HA/PLLA片，38例患者使用u-HA/PLLA网，47例患者使用聚-L-乳酸/聚乙醇酸网，35例患者使用硅胶片，19例患者使用钛网。进行了为期48.2个月的中期随访。进行了图表回顾。研究了术后并发症及其影响因素。使用计算机断层扫描评估重建区域的畸形情况。
使用硅胶片重建的患者术后并发症的发生率明显高于使用u-HA/PLLA片重建的患者。硅胶片（28.6%）和聚-L-乳酸/聚乙醇酸网（31.9%）出现了畸形。这些畸形率明显高于u-HA/PLLA片。
与其他异质材料相比，u-HA/PLLA术后并发症和重建区域畸形的发生率较低。由于其可完全吸收，临床医生应考虑将u-HA/PLLA用作眼眶壁重建的异质材料。
临床问题/证据级别：治疗性，III级。
