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眼眶底骨折治疗中的新兴技术:一项系统综述

Emerging Technologies in the Treatment of Orbital Floor Fractures: A Systematic Review.

作者信息

Helgers Lorena, Prikule Ilze, Salms Girts, Bagante Ieva

机构信息

Riga Stradins University, LV-1010 Riga, Latvia.

Centre of Oral and Maxillofacial Surgery, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia.

出版信息

Medicina (Kaunas). 2025 Jul 23;61(8):1330. doi: 10.3390/medicina61081330.

DOI:10.3390/medicina61081330
PMID:40870375
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12387675/
Abstract

: Orbital floor fractures are challenging to treat, due to the complex orbital anatomy and limited surgical access. Emerging technologies-such as virtual surgical planning (VSP), 3D printing, patient-specific implants (PSIs), and intraoperative navigation-offer promising advancements to improve the surgical precision and clinical outcomes. This review systematically evaluates and synthesizes current technological modalities with respect to their accuracy, operative duration, cost-effectiveness, and postoperative functional outcomes. : A systematic review was conducted according to the PRISMA 2020 guidelines. The PubMed, Scopus, and PRIMO databases were searched for clinical studies published between 2019 and September 2024. Out of 229 articles identified, 9 met the inclusion criteria and were analyzed using the PICO framework. : VSP and 3D printing enhanced diagnostics and presurgical planning, offering improved accuracy and reduced planning time. Pre-bent PSIs shaped on 3D models showed superior accuracy, lower operative times, and better cost efficiency compared to intraoperative mesh shaping. Custom-designed PSIs offered high precision and clinical benefit but required a longer production time. Intraoperative navigation improved implant positioning and reduced the complication rates, though a detailed cost analysis remains limited. : VSP, 3D printing, and intraoperative navigation significantly improve surgical planning and outcomes in orbital floor reconstruction. Pre-bent PSIs provide a time- and cost-effective solution with strong clinical performance. While customized PSIs offer accuracy, they are less practical in time-sensitive settings. Navigation systems are promising tools that enhance outcomes and may serve as an alternative to custom implants when time or resources are limited.

摘要

眼眶底骨折的治疗具有挑战性,这是由于眼眶解剖结构复杂且手术入路有限。诸如虚拟手术规划(VSP)、3D打印、定制植入物(PSI)和术中导航等新兴技术为提高手术精度和临床效果提供了有前景的进展。本综述系统地评估并综合了当前技术模式在准确性、手术时长、成本效益和术后功能结果方面的情况。

根据PRISMA 2020指南进行了系统综述。在PubMed、Scopus和PRIMO数据库中检索了2019年至2024年9月期间发表的临床研究。在识别出的229篇文章中,9篇符合纳入标准,并使用PICO框架进行了分析。

VSP和3D打印增强了诊断和术前规划,提高了准确性并缩短了规划时间。与术中网状塑形相比,在3D模型上塑形的预弯PSI显示出更高的准确性、更短的手术时间和更好的成本效益。定制设计的PSI提供了高精度和临床益处,但生产时间较长。术中导航改善了植入物定位并降低了并发症发生率,不过详细的成本分析仍然有限。

VSP、3D打印和术中导航显著改善了眼眶底重建的手术规划和结果。预弯PSI提供了一种具有良好临床性能的省时且具成本效益的解决方案。虽然定制PSI具有准确性,但在时间敏感的情况下实用性较差。导航系统是有前景的工具,可改善结果,并且在时间或资源有限时可作为定制植入物的替代方案。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5934/12387675/23f2a412da45/medicina-61-01330-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5934/12387675/23f2a412da45/medicina-61-01330-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5934/12387675/23f2a412da45/medicina-61-01330-g001.jpg

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本文引用的文献

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Does a Point-of-Care 3-Dimensional Printer Result in a Decreased Length of Surgery for Orbital Fractures?术中 3D 打印机是否会缩短眼眶骨折手术的时间?
J Oral Maxillofac Surg. 2024 Oct;82(10):1275-1284. doi: 10.1016/j.joms.2024.07.005. Epub 2024 Jul 11.
2
Presurgical Virtual Planning and Intraoperative Navigation with 3D-Preformed Mesh: A New Protocol for Primary Orbital Fracture Reconstruction.使用三维预成型网片进行术前虚拟规划和术中导航:原发性眼眶骨折重建的新方案
Life (Basel). 2024 Apr 6;14(4):482. doi: 10.3390/life14040482.
3
Comparison of patient specific implant reconstruction vs conventional titanium mesh reconstruction of orbital fractures using a novel method.
采用新方法比较个体化植入物重建与传统钛网重建眼眶骨折的效果。
J Craniomaxillofac Surg. 2024 Apr;52(4):491-502. doi: 10.1016/j.jcms.2024.02.002. Epub 2024 Feb 5.
4
Customized orbital implant versus 3D preformed titanium mesh for orbital fracture repair: A retrospective comparative analysis of orbital reconstruction accuracy.定制眼眶植入物与 3D 预制钛网在眼眶骨折修复中的比较:眼眶重建准确性的回顾性对比分析。
J Craniomaxillofac Surg. 2024 Apr;52(4):532-537. doi: 10.1016/j.jcms.2024.02.012. Epub 2024 Feb 5.
5
Epidemiological analysis of patients with isolated blowout fractures of orbital floor: Correlation between demographic characteristics and fracture area.孤立性眶底爆裂性骨折患者的流行病学分析:人口统计学特征与骨折面积的相关性。
J Craniomaxillofac Surg. 2024 Mar;52(3):334-339. doi: 10.1016/j.jcms.2023.10.007. Epub 2023 Oct 19.
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Accuracy of intraoperative navigation for orbital fracture repair: A retrospective morphometric analysis.眼眶骨折修复术中导航的准确性:一项回顾性形态学分析。
J Craniomaxillofac Surg. 2023 Feb;51(2):107-116. doi: 10.1016/j.jcms.2023.01.016. Epub 2023 Feb 2.
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Accuracy of free-hand positioned patient specific implants (PSI) in primary reconstruction after inferior and/or medial orbital wall fractures.徒手定位的患者特异性植入物(PSI)在眶下壁和/或眶内侧壁骨折一期重建中的准确性。
Comput Biol Med. 2021 Oct;137:104791. doi: 10.1016/j.compbiomed.2021.104791. Epub 2021 Aug 27.
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Oral Maxillofac Surg. 2021 Sep;25(3):373-382. doi: 10.1007/s10006-020-00923-x. Epub 2020 Dec 5.