数字化模型制备个性化钛网修复眼眶骨折的应用
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摘要
背景:应用3D打印制作数字化模型可以提高眼眶骨折修复的精确性,有较好的临床应用前景。目的:在数字化模型上制作个性化钛网重建眼眶骨折,评价其治疗效果。方法:选取西南医科大学附属口腔医院2014年1月至2015年10月期间收治的眼眶骨折患者12例,术前行眼眶水平位、冠状位、矢状位CT扫描及三维重建,以CT数据为基础,应用3D打印技术制作数字化模型,在其上制作个性化钛网,术中植入钛网行眼眶重建。术后复查眼眶CT,观察钛网植入位置和眼功能。结果与结论:(1)术后CT显示12例患者植入的个性化钛网均能够精确重建骨折的眼眶,所有患者未出现感染和钛网松动、脱出、排斥现象;(2)以健眼为对照,11例眼球内陷得到完全矫正,1例欠矫治;(3)9例有复视症状的患者,8例复视症状消失,1例复视症状减轻;(4)7例有眼球运动受限的患者,术后均恢复正常;(5)结果表明,个性化预成形钛网在解剖上可以精确地重建眼眶骨折,取得了良好的临床效果。
BACKGROUND:Three-dimensional printing to prepare a digital model can improve the accuracy of orbital fracture repair,and has a good clinical prospect.OBJECTIVE:To evaluate the effect of individualized titanium mesh based on the digital model in the reconstruction of orbital fracture.METHODS:Twelve cases of orbital fracture were admitted at the Hospital of Stomatology,Southwest Medical University from January 2014 to October 2015.CT scanning in axial,coronal,sagittal planes and three-dimensional reconstruction were performed routinely in all cases preoperatively.Digital model was designed by 3D printing technology according to the CT data.Individualized titanium mesh was shaped based on the digital model and used to repair orbital fracture.The accuracy of the reconstructed orbit was assessedbased on the postoperative CT scan.RESULTS AND CONCLUSION:Postoperative CT scans showed that the implanted individualized titanium meshes were capable of accurately reconstructing the fractured orbit in all the 12 patients,and there was no infection,and titanium mesh loosening,prolapse,and rejection.With healthy eyes as controls,11 cases of eyeball retraction were corrected completely,and only 1 case was still under correction.Diplopia symptoms disappeared in the 8 of 9 cases,and relieved in the 1 of 9 cases.Seven cases of eye movement limitation recovered postoperatively.To conclude,the individualized titanium mesh has great accuracy to repair orbital fractures in patients without serious complications,which has achieved good clinical outcomes in the orbital reconstruction.
BACKGROUND:Three-dimensional printing to prepare a digital model can improve the accuracy of orbital fracture repair,and has a good clinical prospect.OBJECTIVE:To evaluate the effect of individualized titanium mesh based on the digital model in the reconstruction of orbital fracture.METHODS:Twelve cases of orbital fracture were admitted at the Hospital of Stomatology,Southwest Medical University from January 2014 to October 2015.CT scanning in axial,coronal,sagittal planes and three-dimensional reconstruction were performed routinely in all cases preoperatively.Digital model was designed by 3D printing technology according to the CT data.Individualized titanium mesh was shaped based on the digital model and used to repair orbital fracture.The accuracy of the reconstructed orbit was assessedbased on the postoperative CT scan.RESULTS AND CONCLUSION:Postoperative CT scans showed that the implanted individualized titanium meshes were capable of accurately reconstructing the fractured orbit in all the 12 patients,and there was no infection,and titanium mesh loosening,prolapse,and rejection.With healthy eyes as controls,11 cases of eyeball retraction were corrected completely,and only 1 case was still under correction.Diplopia symptoms disappeared in the 8 of 9 cases,and relieved in the 1 of 9 cases.Seven cases of eye movement limitation recovered postoperatively.To conclude,the individualized titanium mesh has great accuracy to repair orbital fractures in patients without serious complications,which has achieved good clinical outcomes in the orbital reconstruction.
引文
[1]许雯,赵传亮,金玲,等.单纯性眶壁爆裂骨折的临床分析[J].临床耳鼻咽喉头颈外科杂志,2015,29(5):418-421.
[2]Chaudhary R,Upendran M,Campion N,et al.The role of computerised tomography in predicting visual outcome in ocular trauma patients.Eye(Lond).2015;29(7):867-871.
[3]Pagnoni M,Marenco M,Ramieri V,et al.Late treatment of orbital fractures:a new analysis for surgical planning.Acta Otorhinolaryngol Ital.2014;34(6):439-445.
[4]张云绮,贾保军,敖建华,等.3D打印技术在下颌骨缺损修复中应用的初步临床研究[J].口腔医学研究,2016,32(5):517-523.
[5]张庆福,刘刚,刘国勤.个体化3D打印钛合金下颌骨植入体的设计制作与临床应用[J].口腔医学研究,2015,31(1):48-51.
[6]韩宝红.被动牵拉试验在眼眶爆裂性骨折修复手术中的应用[J].国际眼科杂志,2014,14(5):959-960
[7]王兆艳,阴正勤,魏世辉,等.预成形钛网在眼眶骨折眶壁修复中的应用[J].南方医科大学学报,2013,33(7):1071-1074.
[8]刘观华,张志强,范钦华,等.眼眶骨折修复的人工材料的研究进展[J].临床眼科杂志,2015,23(1):87-89.
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[10]Yi WS,Xu XL,Ma JR,et al.Reconstruction of complex orbital fracture with titanium implants.Int J Ophthalmol.2012;5(4):488-492.
[11]Degala S,Shetty SK,Biddappa L.Reconstruction of Post-traumatic Internal Orbital Wall Defects with Titanium Mesh.J Maxillofac Oral Surg.2013;12(4):418-423.
[12]孙凯建,王春霞,王雅文,等.应用个体化预成型钛网修复眶下壁骨折的临床分析[J].国际眼科杂志,2016,16(4):745-747.
[13]陈明,柴广睿,王梦,等.应用AO三维预成型钛网治疗眼眶骨折的临床研究[J].国际眼科杂志,2015,15(1):112-116.
[14]Boyette JR,Pemberton JD,Bonilla-Velez J.Management of orbital fractures:challenges and solutions.Clin Ophthalmol.2015;9:2127-2137.
[15]管吉,杨树欣,管叶,等.3D打印技术在医疗领域的研究进展[J].中国医疗设备,2014,29(4):71-72.
[16]Thomas DJ,Azmi MABM,Tehrani Z.3D additive manufacture of oral and maxillofacial surgical models for preoperative planning.International Journal of Advanced Manufacturing Technology.2014;71(9-12):1643-1651.
[17]秦勉,刘亚雄,贺健康,等.数字化设计与3-D打印技术在个性化医疗中的应用[J].中国修复重建外科杂志,2014,28(3):286-291.
[18]黄立,林李嵩,王志红,等.基于眼球三维空间精确定位测量的外伤性眼眶缺损的个体化重建[J].中国口腔颌面外科杂志,2014,12(2):136-143.
[19]Wan KH,Chong KK,Young AL.The Role of Computer-Assisted Technology in Post-Traumatic Orbital Reconstruction:A PRISMA-driven Systematic Review.Sci Rep.2015;5:17914.
[20]陈春艳,张力,鲍海宏.计算机三维塑形钛网在眶壁缺损修复中的临床应用[J].临床口腔医学杂志,2016,32(4):237-238.
[21]张翔,陈伟,曹罡,等.计算机辅助快速成型钛网在眼眶爆裂骨折整复中的应用[J].医学研究生学报,2016,29(4):407-410.
[22]Susarla SM,Duncan K,Mahoney NR,et al.Virtual Surgical Planning for Orbital Reconstruction.Middle East Afr JOphthalmol.2015;22(4):442-446.
[23]Zavattero E,Ramieri G,Roccia F,et al.Comparison of the Outcomes of Complex Orbital Fracture Repair with and without a Surgical Navigation System:A Prospective Cohort Study with Historical Controls.Plast Reconstr Surg.2017;139(4):957-965.
[24]Oh TS,Jeong WS,Chang TJ,et al.Customized Orbital Wall Reconstruction Using Three-Dimensionally Printed Rapid Prototype Model in Patients With Orbital Wall Fracture.JCraniofac Surg.2016;27(8):2020-2024.
[25]Callahan AB,Campbell AA,Petris C,et al.Low-Cost 3DPrinting Orbital Implant Templates in Secondary Orbital Reconstructions.Ophthal Plast Reconstr Surg.2017 Feb 22.[Epub ahead of print]
[26]彭昌福,李婵.CAD/CAM技术在眼眶重建中的应用研究[J].国际眼科杂志,2016,16(5):993-995.
[27]Jansen J,Schreurs R,Dubois L,et al.Orbital volume analysis:validation of a semi-automatic software segmentation method.Int J Comput Assist Radiol Surg.2016;11(1):11-18.
[28]Shyu VB,Hsu CE,Chen CH,et al.3D-assisted quantitative assessment of orbital volume using an open-source software platform in a Taiwanese population.PLo S One.2015;10(3):e0119589.
[29]蒋丽琼,何小琴,刘桂琴,等.利用Image J软件测量眼眶脂肪体积[J].中国CT和MRI杂志,2016,14(3):11-13.
[30]傅杰,赵佳威.眼眶骨折整复重建前后视力和眼球运动功能研究[J].国际眼科杂志,2016,16(2):367-369.
[31]孙黎波,肖金刚,兰玉燕,等.个性化钛网联合多孔高密度聚乙烯矫眼眶骨折伴眼球内陷畸形[J].华西口腔医学杂志,2015,33(3):272-275.
[32]Peng MY,Merbs SL,Grant MP,et al.Orbital fracture repair outcomes with preformed titanium mesh implants and comparison to porous polyethylene coated titanium sheets.JCraniomaxillofac Surg.2017;45(2):271-274.
[2]Chaudhary R,Upendran M,Campion N,et al.The role of computerised tomography in predicting visual outcome in ocular trauma patients.Eye(Lond).2015;29(7):867-871.
[3]Pagnoni M,Marenco M,Ramieri V,et al.Late treatment of orbital fractures:a new analysis for surgical planning.Acta Otorhinolaryngol Ital.2014;34(6):439-445.
[4]张云绮,贾保军,敖建华,等.3D打印技术在下颌骨缺损修复中应用的初步临床研究[J].口腔医学研究,2016,32(5):517-523.
[5]张庆福,刘刚,刘国勤.个体化3D打印钛合金下颌骨植入体的设计制作与临床应用[J].口腔医学研究,2015,31(1):48-51.
[6]韩宝红.被动牵拉试验在眼眶爆裂性骨折修复手术中的应用[J].国际眼科杂志,2014,14(5):959-960
[7]王兆艳,阴正勤,魏世辉,等.预成形钛网在眼眶骨折眶壁修复中的应用[J].南方医科大学学报,2013,33(7):1071-1074.
[8]刘观华,张志强,范钦华,等.眼眶骨折修复的人工材料的研究进展[J].临床眼科杂志,2015,23(1):87-89.
[9]Totir M,Ciuluvica R,Dinu I,et al.Biomaterials for orbital fractures repair.J Med Life.2015;8(1):41-43.
[10]Yi WS,Xu XL,Ma JR,et al.Reconstruction of complex orbital fracture with titanium implants.Int J Ophthalmol.2012;5(4):488-492.
[11]Degala S,Shetty SK,Biddappa L.Reconstruction of Post-traumatic Internal Orbital Wall Defects with Titanium Mesh.J Maxillofac Oral Surg.2013;12(4):418-423.
[12]孙凯建,王春霞,王雅文,等.应用个体化预成型钛网修复眶下壁骨折的临床分析[J].国际眼科杂志,2016,16(4):745-747.
[13]陈明,柴广睿,王梦,等.应用AO三维预成型钛网治疗眼眶骨折的临床研究[J].国际眼科杂志,2015,15(1):112-116.
[14]Boyette JR,Pemberton JD,Bonilla-Velez J.Management of orbital fractures:challenges and solutions.Clin Ophthalmol.2015;9:2127-2137.
[15]管吉,杨树欣,管叶,等.3D打印技术在医疗领域的研究进展[J].中国医疗设备,2014,29(4):71-72.
[16]Thomas DJ,Azmi MABM,Tehrani Z.3D additive manufacture of oral and maxillofacial surgical models for preoperative planning.International Journal of Advanced Manufacturing Technology.2014;71(9-12):1643-1651.
[17]秦勉,刘亚雄,贺健康,等.数字化设计与3-D打印技术在个性化医疗中的应用[J].中国修复重建外科杂志,2014,28(3):286-291.
[18]黄立,林李嵩,王志红,等.基于眼球三维空间精确定位测量的外伤性眼眶缺损的个体化重建[J].中国口腔颌面外科杂志,2014,12(2):136-143.
[19]Wan KH,Chong KK,Young AL.The Role of Computer-Assisted Technology in Post-Traumatic Orbital Reconstruction:A PRISMA-driven Systematic Review.Sci Rep.2015;5:17914.
[20]陈春艳,张力,鲍海宏.计算机三维塑形钛网在眶壁缺损修复中的临床应用[J].临床口腔医学杂志,2016,32(4):237-238.
[21]张翔,陈伟,曹罡,等.计算机辅助快速成型钛网在眼眶爆裂骨折整复中的应用[J].医学研究生学报,2016,29(4):407-410.
[22]Susarla SM,Duncan K,Mahoney NR,et al.Virtual Surgical Planning for Orbital Reconstruction.Middle East Afr JOphthalmol.2015;22(4):442-446.
[23]Zavattero E,Ramieri G,Roccia F,et al.Comparison of the Outcomes of Complex Orbital Fracture Repair with and without a Surgical Navigation System:A Prospective Cohort Study with Historical Controls.Plast Reconstr Surg.2017;139(4):957-965.
[24]Oh TS,Jeong WS,Chang TJ,et al.Customized Orbital Wall Reconstruction Using Three-Dimensionally Printed Rapid Prototype Model in Patients With Orbital Wall Fracture.JCraniofac Surg.2016;27(8):2020-2024.
[25]Callahan AB,Campbell AA,Petris C,et al.Low-Cost 3DPrinting Orbital Implant Templates in Secondary Orbital Reconstructions.Ophthal Plast Reconstr Surg.2017 Feb 22.[Epub ahead of print]
[26]彭昌福,李婵.CAD/CAM技术在眼眶重建中的应用研究[J].国际眼科杂志,2016,16(5):993-995.
[27]Jansen J,Schreurs R,Dubois L,et al.Orbital volume analysis:validation of a semi-automatic software segmentation method.Int J Comput Assist Radiol Surg.2016;11(1):11-18.
[28]Shyu VB,Hsu CE,Chen CH,et al.3D-assisted quantitative assessment of orbital volume using an open-source software platform in a Taiwanese population.PLo S One.2015;10(3):e0119589.
[29]蒋丽琼,何小琴,刘桂琴,等.利用Image J软件测量眼眶脂肪体积[J].中国CT和MRI杂志,2016,14(3):11-13.
[30]傅杰,赵佳威.眼眶骨折整复重建前后视力和眼球运动功能研究[J].国际眼科杂志,2016,16(2):367-369.
[31]孙黎波,肖金刚,兰玉燕,等.个性化钛网联合多孔高密度聚乙烯矫眼眶骨折伴眼球内陷畸形[J].华西口腔医学杂志,2015,33(3):272-275.
[32]Peng MY,Merbs SL,Grant MP,et al.Orbital fracture repair outcomes with preformed titanium mesh implants and comparison to porous polyethylene coated titanium sheets.JCraniomaxillofac Surg.2017;45(2):271-274.