预塑形钛网植入对眼眶骨折手术治疗预后的影响
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摘要
目的:探讨与常规钛网手术植入相较,3D打印的预塑形钛网在眼眶骨折修复中的有效性和安全性。方法:选择2015-06/2016-03来我院眼科就诊的眼眶骨折患者72例72眼进行回顾性分析。全部病例分为两组,其中预塑形钛网植入组(观察组)40例40眼,常规钛网植入组(对照组)32例32眼。对照组由医师根据经验手工弯制和塑形衬垫钛网植入患侧眼眶;观察组由医师直接在患侧眼眶植入3D打印的预塑形钛网。在术后1、3、6mo复查眼球内陷、复视、眼球运动恢复情况,比较两种方法各观察指标在手术前后不同时间点的组内差异,及同一时间点两种材料间各指标的组间差异。结果:观察组和对照组眼球内陷治愈率分别为84%、59%,两组相比,差异有统计学意义(P<0.05);观察组和对照组复视治愈率分别为80%和70%,两组相比差异无统计学意义(P>0.05);观察组眼球运动受限治愈率为73%,对照组治愈率为66%,两组相比,无显著统计学意义(P>0.05)。术后随访期间两组均无感染,无钛网移位、脱出、变形及排斥等并发症。结论:预塑形钛网植入眼眶骨折患者手术术中无需塑形,可缩短手术时间,重建眶壁确切,减少手术并发症,提高疗效。
AIM:To study the effectiveness and safety of 3D printing pre-shaped titanium mesh in the repair of orbital fracture compared with the conventional titanium mesh.METHODS:The clinical data of 72 eyes of 72 patients who received surgery for orbital fracture from June 2015 to March 2016 in our department were retrospectively analyzed.All patients were divided into two groups,including pre-shaped titanium mesh implantation group(observation group),40 cases,conventional titanium mesh implantation group(control group),32 cases.The control group was treated by physicians according to the experience of manual bending and shaping titanium mesh implantation ipsilateral orbital pad,when the observation group by the physicians directly in the pre-shaped titanium mesh of 3D printing.The eyeball exophthalmos,eye movement and diplopia were evaluated in the next 1,3 and 6mo after the operation,and we compared the differences between the two methods at different time points and the differences of the indexes between the two materials at the same time point.RESULTS:The cure rate of the observation group and the control group about eyeball exophthalmos values was 84%and 59%,the difference of the two groups was statistically significant(P<0.05).The cure rates of diplopia of the two groups were 80%and 70%without significant difference(P>0.05).The cure rate of limited ocular movement of observation group was 73%,that of control group was 66%,there was no statistical significance(P>0.05).During the follow-up period,there was no infection in the two groups,no titanium mesh shift,extrusion,deformation and rejection or other complications.CONCLUSION:Pre-shaped titanium mesh shaping orbital implantation with no need for shaping the mesh in the operation,can shorten the operation time,make accurate reconstruction of orbital wall,reduce complications and improve the curative effect.
AIM:To study the effectiveness and safety of 3D printing pre-shaped titanium mesh in the repair of orbital fracture compared with the conventional titanium mesh.METHODS:The clinical data of 72 eyes of 72 patients who received surgery for orbital fracture from June 2015 to March 2016 in our department were retrospectively analyzed.All patients were divided into two groups,including pre-shaped titanium mesh implantation group(observation group),40 cases,conventional titanium mesh implantation group(control group),32 cases.The control group was treated by physicians according to the experience of manual bending and shaping titanium mesh implantation ipsilateral orbital pad,when the observation group by the physicians directly in the pre-shaped titanium mesh of 3D printing.The eyeball exophthalmos,eye movement and diplopia were evaluated in the next 1,3 and 6mo after the operation,and we compared the differences between the two methods at different time points and the differences of the indexes between the two materials at the same time point.RESULTS:The cure rate of the observation group and the control group about eyeball exophthalmos values was 84%and 59%,the difference of the two groups was statistically significant(P<0.05).The cure rates of diplopia of the two groups were 80%and 70%without significant difference(P>0.05).The cure rate of limited ocular movement of observation group was 73%,that of control group was 66%,there was no statistical significance(P>0.05).During the follow-up period,there was no infection in the two groups,no titanium mesh shift,extrusion,deformation and rejection or other complications.CONCLUSION:Pre-shaped titanium mesh shaping orbital implantation with no need for shaping the mesh in the operation,can shorten the operation time,make accurate reconstruction of orbital wall,reduce complications and improve the curative effect.
引文
1张沧霞,郑艳霞,王义军.眼眶骨折168例临床分析.眼科新进展2014;34(9):849-851
2任彦新,马景学,卫玉彩.计算机辅助预成形钛网整体修复复合性眼眶骨折应用分析.中国实用眼科杂志2013;31(5):627-630
3耿玉欣.计算机辅助预成形钦网在眼眶复合性骨折整复中的临床应用研究.河北医科大学2011
4宋国祥.眼眶病学.北京:人民卫生出版社2010:457
5王兆艳,阴正勤,魏世辉.预成形钛网在眼眶骨折眶壁修复中的应用.南方医科大学学报2013;33(7):1071-1074
6张智勇,冯志强,巩玺,等.计算机导航在单侧眼眶骨折眶壁重建中的应用评价.中华口腔医学杂志2012;47(11):657-661
7安金刚,张益,张智勇.计算机辅助制作个性化钛网治疗眼眶骨折继发眼球内陷.北京大学学报(医学版)2008;40(1):88-91
8张翔,陈伟,曹罡.计算机辅助快速成型钦网在眼眶爆裂骨折整复中的应用.医学研究生学报2016;29(4):407-410
9贾保平.36例眼眶骨折患者的临床诊治分析.中国中医眼科杂志2016;26(2):106-107
10卢利,自晓峰,杨鸣良,等.复合性眼眶骨折整复术相关问题的分析.中华口腔医学杂志2011;46(8):458-462
11Adeyemo WL,Aribaba OT,Ladehinde AL,et al.Mechanisms of orbital blowout fracture:a critical review of the literature.Niger Postgrad Med2008;15(4):251-254
12孙凯建,王春霞,王雅文.应用个体化预成型钦网修复眶下壁骨折的临床分析.国际眼科杂志2016;16(4):745-746
13程时富,查蕾蕾,李小明.不同修复材料在眼眶爆裂性骨折中的应用.川北医学院学报2014;29(4):375-378
14李建明,宋晓红,田蕊蕊.Medpor植入治疗眼眶爆裂性骨折56例疗效观察.临床医学2012;32(1):99-101
15陈明,柴广睿,王梦.应用AO三维预成形钛网在治疗眼眶骨折的临床应用.国际眼科杂志2015;15(1):112-116
16方红丽.Medpor和钛网在眼眶爆裂性骨折中的临床应用.中南大学2014
17周佩佩.钛网联合Medpor在眼眶骨折中的临床应用.南昌大学医学院2015
18任彦新,马景学,卫玉彩.计算机辅助预成形钛网整体修复复合性眼眶骨折应用分析.中国实用眼科杂志2013;31(5):627-630
19郑嵩山,战云,柴昌.计算机辅助设计与制作技术在眼眶爆裂性骨折治疗中的应用及疗效评价.中华实验杂志2015;33(8):727-732
20张益.数字化外科技术及眼眶骨折精确重建.中华口腔医学杂志2012;47(8):465-467
2任彦新,马景学,卫玉彩.计算机辅助预成形钛网整体修复复合性眼眶骨折应用分析.中国实用眼科杂志2013;31(5):627-630
3耿玉欣.计算机辅助预成形钦网在眼眶复合性骨折整复中的临床应用研究.河北医科大学2011
4宋国祥.眼眶病学.北京:人民卫生出版社2010:457
5王兆艳,阴正勤,魏世辉.预成形钛网在眼眶骨折眶壁修复中的应用.南方医科大学学报2013;33(7):1071-1074
6张智勇,冯志强,巩玺,等.计算机导航在单侧眼眶骨折眶壁重建中的应用评价.中华口腔医学杂志2012;47(11):657-661
7安金刚,张益,张智勇.计算机辅助制作个性化钛网治疗眼眶骨折继发眼球内陷.北京大学学报(医学版)2008;40(1):88-91
8张翔,陈伟,曹罡.计算机辅助快速成型钦网在眼眶爆裂骨折整复中的应用.医学研究生学报2016;29(4):407-410
9贾保平.36例眼眶骨折患者的临床诊治分析.中国中医眼科杂志2016;26(2):106-107
10卢利,自晓峰,杨鸣良,等.复合性眼眶骨折整复术相关问题的分析.中华口腔医学杂志2011;46(8):458-462
11Adeyemo WL,Aribaba OT,Ladehinde AL,et al.Mechanisms of orbital blowout fracture:a critical review of the literature.Niger Postgrad Med2008;15(4):251-254
12孙凯建,王春霞,王雅文.应用个体化预成型钦网修复眶下壁骨折的临床分析.国际眼科杂志2016;16(4):745-746
13程时富,查蕾蕾,李小明.不同修复材料在眼眶爆裂性骨折中的应用.川北医学院学报2014;29(4):375-378
14李建明,宋晓红,田蕊蕊.Medpor植入治疗眼眶爆裂性骨折56例疗效观察.临床医学2012;32(1):99-101
15陈明,柴广睿,王梦.应用AO三维预成形钛网在治疗眼眶骨折的临床应用.国际眼科杂志2015;15(1):112-116
16方红丽.Medpor和钛网在眼眶爆裂性骨折中的临床应用.中南大学2014
17周佩佩.钛网联合Medpor在眼眶骨折中的临床应用.南昌大学医学院2015
18任彦新,马景学,卫玉彩.计算机辅助预成形钛网整体修复复合性眼眶骨折应用分析.中国实用眼科杂志2013;31(5):627-630
19郑嵩山,战云,柴昌.计算机辅助设计与制作技术在眼眶爆裂性骨折治疗中的应用及疗效评价.中华实验杂志2015;33(8):727-732
20张益.数字化外科技术及眼眶骨折精确重建.中华口腔医学杂志2012;47(8):465-467