Associate Professor, Department of Oral and Maxillofacial Surgery, University of Rochester, Rochester, NY.
Resident-in-Training, Department of Surgery, University of Florida at Jacksonville, Jacksonville, FL.
J Oral Maxillofac Surg. 2024 Oct;82(10):1275-1284. doi: 10.1016/j.joms.2024.07.005. Epub 2024 Jul 11.
Utilization of point-of-care 3-dimensional printing (3DP) has decreased length of surgery in facial trauma. Little is known regarding 3DP's impact on length of surgery in orbital fracture.
The purpose of this study was to compare length of surgery between 3DP/preadapted (3DPPA) orbital plates and intraoperative adapted plates (IOAP) for orbital fracture reconstruction.
STUDY DESIGN, SETTING, SAMPLE: This was a prospective, non-blinded, randomized clinical study of consecutive subjects with orbital fractures presented to Grady Memorial Hospital in Atlanta, Georgia, between January 2018 and June 2021. Subjects ≥ 18 years, unilateral fracture, no previous orbital surgery, and/or congenital craniofacial anomaly were included. We excluded subjects <18 years and bilateral fractures.
PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE: Primary predictor variable was the treatment approach. Randomization software was used, and subjects were randomized to 3DPPA or IOAP groups.
MAIN OUTCOME VARIABLE(S): Primary outcome variable was length of surgery in minutes. Secondary outcomes were the time required for plate insertion and fixation in minutes, operating room (OR) charges, and orbital volume (OV) calculation.
Age, sex, race, etiology, laterality, location, dimension, indication for surgery, postoperative enophthalmos, and diplopia.
Univariate and bivariate analyses were calculated. Statistical significance was P < .05.
Twenty-five subjects met the inclusion criteria. Mean ages in 3DPPA and conventional IOAP groups were 41.5 (±9) and 38.2 (±10, P = .31), respectively. The mean length of surgery was 32.6 (±13.7) in 3DPPA and 53.3 (±12.8, P < .001) in conventional IOAP. The mean time required for plate insertion and fixation was 15.8n (±14.4) in 3DPPA and 41.4 (±9.4, P < .001) in conventional IOAP. The mean OR charges were $1,072.5 (±524.6) in 3DPPA and $1,757.3 (±422.6, P ≤ 0.001) in conventional IOAP. The mean calculated OV of uninjured and reconstructed orbit for the 3DPPA was 23.5 (±3.2)cm and 23 (±3.5, P = .37)cm, respectively. The mean calculated OV of uninjured and reconstructed orbit for conventional IOAP was 28.6 (±3.6)cm and 22.8 (±2.6, P < .001)cm, respectively.
Using 3DP to produce a model that enables preoperative plate bending/adaptation reduces the length of surgery, decreases OR charges, and results in predictable OV.
在面部创伤中，即时使用的三维打印（3DP）技术可减少手术时间。然而，关于 3DP 对眼眶骨折手术时间的影响，我们知之甚少。
本研究旨在比较 3DP/预适应（3DPPA）眼眶板与术中适应板（IOAP）在眼眶骨折重建中的手术时间。
研究设计、地点和样本：这是一项前瞻性、非盲法、随机临床研究，纳入了 2018 年 1 月至 2021 年 6 月期间在佐治亚州亚特兰大市 Grady Memorial 医院就诊的单侧眼眶骨折的连续患者。纳入标准为年龄≥18 岁、单侧骨折、无既往眼眶手术史和/或先天性颅面畸形。排除标准为年龄<18 岁和双侧骨折。
预测因素/暴露/独立变量：主要预测因素是治疗方法。使用随机软件将患者随机分为 3DPPA 或 IOAP 组。
主要结局变量是手术时间（分钟）。次要结局变量为板插入和固定时间（分钟）、手术室（OR）费用和眶容积（OV）计算。
年龄、性别、种族、病因、侧别、位置、尺寸、手术适应证、术后眼球内陷和复视。
进行单变量和双变量分析。统计显著性水平为 P<0.05。
符合纳入标准的患者有 25 名。3DPPA 和传统 IOAP 组的平均年龄分别为 41.5（±9）和 38.2（±10，P=0.31）。3DPPA 的平均手术时间为 32.6（±13.7）分钟，传统 IOAP 为 53.3（±12.8，P<0.001）分钟。3DPPA 的板插入和固定平均时间为 15.8n（±14.4）分钟，传统 IOAP 为 41.4（±9.4，P<0.001）分钟。3DPPA 的 OR 费用为 1072.5（±524.6）美元，传统 IOAP 为 1757.3（±422.6，P≤0.001）美元。3DPPA 未受伤和重建眼眶的平均 OV 分别为 23.5（±3.2）cm 和 23（±3.5，P=0.37）cm。传统 IOAP 未受伤和重建眼眶的平均 OV 分别为 28.6（±3.6）cm 和 22.8（±2.6，P<0.001）cm。
使用 3DP 制作可预先弯曲/适应的模型可减少手术时间、降低 OR 费用，并使眶容积具有可预测性。
