Park Dong Ha, Lee Jun Suk, Jung Yeon Kyo, Lim Hyoseob
Department of Plastic and Reconstructive Surgery, Ajou University School of Medicine, Suwon, Gyeonggi-do, Republic of Korea.
J Craniofac Surg. 2024 Sep 16;35(8):2264-8. doi: 10.1097/SCS.0000000000010647.
Orbital wall reconstruction and implant insertion are crucial procedures for temporarily replacing the orbital walls in cases of significant fractures. Traditional methods using planar orbital implants have faced challenges owing to their flat shape, which increases the risk of dislocation from improper cuts and necessitates the use of screws in the orbital rim. This study aims to improve outcomes by employing customized 3-dimensional implants, thereby reducing complications and risk of dislocation resulting from external shock or implant weight postinsertion. This prospective study included 12 Korean individuals diagnosed with facial fractures (orbital wall injuries). Surgeries were performed on 12 patients, and follow-up CT scans were conducted on 10 of them. Therefore, the authors could only address the results for the 10 patients. The authors used bioactive glass ceramics and medical-grade poly-e-caprolactone to 3D print personalized implants, completing the manufacturing process in an average of 4.6 days. Computed tomography scans guided measurements of orbital volumes and exophthalmos. After surgery, we found that the difference values for bone orbital volumes (<0.1 mL) and exophthalmos (<1 mm except one) decreased compared with presurgery values. Independent t tests and Pearson correlation analysis revealed no significant changes between normal and affected sides in both phases. However, R-values increased in the postsurgery phase. Patients monitored postsurgery at 2 weeks, 3 months, and 6 months showed no complications. The 3D-printed patient-specific implants, customized to individual fracture shapes and featuring distinct implants and locking parts with notches, effectively restore bony orbital volumes and reduce exophthalmos. They have been proven feasible and applicable for reconstructing acute orbital wall fractures.
眼眶壁重建和植入物植入是在严重骨折情况下临时替代眼眶壁的关键手术。传统的平面眼眶植入物方法因其扁平形状面临挑战，这种形状会因切割不当而增加脱位风险，并且需要在眼眶边缘使用螺钉。本研究旨在通过采用定制的三维植入物来改善治疗效果，从而减少外部冲击或植入后植入物重量导致的并发症和脱位风险。这项前瞻性研究纳入了12名被诊断为面部骨折（眼眶壁损伤）的韩国人。对12名患者进行了手术，其中10名患者进行了术后CT扫描。因此，作者只能阐述这10名患者的结果。作者使用生物活性玻璃陶瓷和医用级聚己内酯进行3D打印个性化植入物，平均4.6天完成制造过程。计算机断层扫描引导下测量眼眶容积和眼球突出度。手术后，我们发现眼眶骨容积的差值（<0.1 mL）和眼球突出度的差值（除1例<1 mm外）与术前相比有所降低。独立t检验和Pearson相关性分析显示，两个阶段正常侧和患侧之间均无显著变化。然而，术后阶段的R值有所增加。术后2周、3个月和6个月进行监测的患者未出现并发症。3D打印的针对个体骨折形状定制的植入物，具有独特的植入物和带缺口的锁定部件，能有效恢复眼眶骨容积并减少眼球突出度。它们已被证明对于重建急性眼眶壁骨折是可行且适用的。
