Patel Shivam, Shokri Tom, Ziai Kasra, Lighthall Jessyka G
Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA.
Department of Otolaryngology-Head and Neck Surgery, Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, TX, USA.
Craniomaxillofac Trauma Reconstr. 2022 Sep;15(3):237-245. doi: 10.1177/19433875211026430. Epub 2021 Jun 24.
Substantial controversy exists regarding the timing of intervention and management of patients with orbital floor fractures. Recent advances in computer-aided technology, including the use of 3-dimensional printing, intraoperative navigational imaging, and the use of novel implants, have allowed for improvement in prospective management modalities. As such, this article aims to review the indications and timing of repair, surgical approaches, materials used for repair, and contemporary adjuncts to repair. Indications for orbital floor fracture repair remain controversial as many of these fractures heal without intervention or adverse sequelae. Intraoperative navigation and imaging, as well as endoscopic guidance, can improve visualization of defects mitigating implant positioning errors, thereby reducing the need for secondary corrective procedures. Patient-specific implants may be constructed to fit the individual patient's anatomy using the preoperative CT dataset and mirroring the contralateral unaffected side and have been shown to improve pre-operative efficiency and minimize postoperative complications. With increased data, we can hope to form evidence-based indications for using particular biomaterials and the criteria for orbital defect characteristics, which may be best addressed by a specific surgical approach.
关于眼眶底骨折患者的干预时机和治疗，存在大量争议。计算机辅助技术的最新进展，包括三维打印的应用、术中导航成像以及新型植入物的使用，使得前瞻性治疗方式得到了改进。因此，本文旨在综述修复的适应症和时机、手术方法、修复所用材料以及当代修复辅助手段。眼眶底骨折修复的适应症仍存在争议，因为许多此类骨折无需干预即可愈合，也不会出现不良后遗症。术中导航和成像以及内镜引导可以改善对缺损的可视化，减少植入物定位错误，从而减少二次矫正手术的需求。可以使用术前CT数据集并镜像对侧未受影响的一侧，为个体患者构建定制的植入物，以适应其解剖结构，并且已证明这可以提高术前效率并将术后并发症降至最低。随着数据的增加，我们有望形成使用特定生物材料的循证适应症以及眼眶缺损特征的标准，这可能通过特定的手术方法得到最佳解决。
