| Objective:By comparing the clinical efficacy of absorbable materials(PLLA)and Medpor artificial bone slices in the fracture of fractured orbital wall,the clinical application value of absorbable materials(PLLA)was clarified.Method:40 cases(40 eyes)of ruptured orbital wall fracture were collected in the eye trauma department of the third hospital of hebei medical university from August 2015 to June 2017.There were 40 cases with different degrees of enophthalmos,26 cases with double vision,and 10 cases with obvious ocular muscle incarceration(traction test positive)resulting in eye movement disorder.These patients were divided into two groups: A(n=20)and B(n=20).In group A,14 patients had double vision and 6 patients had obvious eye muscle incarceration leading to eye movement disorder.In group B,12 patients had double vision,and 4 patients had obvious ocular muscle incarceration resulting in eye movement disorder.In the surgery for the correction of orbital wall fractures,it is stipulated that all patients in group A use high-density polyethylene(Medpor)as the implant material,while patients in group B use absorbable materials(PLLA)as the implant material.The changes of visual acuity,eye position,eye movement,enophthalmia and diplopia in the two groups before and after surgery(1 week,1,3 and 6 months after surgery)were compared for statistical analysis.Results:1.Enophthalmos :All 40 patients had different degrees of enophthalmos.At 1 week after surgery,15 patients in group A were cured and 5 were improved.At 1 month,3 months and 6 months after surgery,19 cases were cured and 1 case was not effective,and there were still slight endoscopic sinus,which was a patient who had surgery 9 months after the injury.At 1week after surgery,16 patients in group B were cured and 4 were improved.At 1 month,3 months and 6 months after surgery,19 cases were cured and 1case was not effective,and there was still a slight depression,which meant that the orbital wall fracture defect of the patient was large,and the pupil dilation occurred during the separation.After the symptomatic treatment,the material was withdrawn,leading to the incomplete correction of the depression.through the comparative study with materials can be absorbed(PLLA)and Medpor artificial bone in blowout orbital wall fracture of enophthalmos caused by data,we found that the preoperative and postoperative 1 week,1month,3 months to check the result differences were statistical performance for P<0.05,suggesting that the two kinds of materials,effective treatment,but was statistically significant,consideration and absorbable materials absorption aseptic inflammation in the process of production,so a slight difference between two groups in the process;The results showed that the statistical performance was P > 0.05,with no significant difference.It can be found that the two materials differ slightly in the degree of correction of ocular prominence within 3 months after surgery.With the absorption of edema and inflammation,three months later,the patient’s enophthalmos showed a stable condition,and there was no difference between the two groups of materials in terms of long-term correction of enophthalmos.2.Diplopia:Of the 40 patients,26 had double vision at different levels,among which 14 had double vision in group A(grade I and grade II were 10 and 4,respectively),and 6 had no double vision.In group B,there were 12 cases of double vision(grade I and grade II were 9 cases and 3 cases,respectively),and 8 cases of no double vision.After treatment,there were 10 cases of grade I double vision,1 case of grade II double vision and 9 cases of no double vision 1 week after surgery in group A.At 1 month,there were 1case of grade I double vision and 19 cases of no double vision.1 week after the operation of group B,the symptoms of double vision were: 10 cases of grade I,1 case of grade II,and 9 cases of no double vision.At 1 month,therewere 15 cases of grade I double vision and 5 cases of no double vision.In both groups,the patients had double vision 3 or 6 months after treatment: 1 patient had grade I double vision and 19 patients had no double vision.By comparing the data of absorbable materials(PLLA)and Medpor artificial bone slices in the aspect of double vision caused by explosive orbital wall fracture,it was found that there was no statistical difference(Z=-0.305,P> 0.05)at the first week after surgery.It was considered that there was no significant correlation between the two materials and edema caused by surgery.At 1 month after surgery,the data showed statistically significant differences(Z=-4.527,P< 0.05).The comparison showed that the absorbable materials group was slightly worse than before,which was considered to be related to the aggravation of the symptom of double vision caused by sterile inflammation caused by absorbable materials during the absorption process.The data at 3 and 6 months after surgery showed no statistical significance(Z=0,P>0.05),indicating that the two materials had different rates of improvement of symptoms of double vision due to different mechanisms,but the final results were not different.3.Eye movement: Of the 40 patients,10 had obvious ocular muscle incarceration(traction test positive),which resulted in eye movement disorder,and the group A showed 14 patients without eye movement disorder and 6patients with grade I eye movement disorder.In group B,there were 4 patients with grade I ocular movement disorder and 16 patients without ocular movement disorder.After symptomatic treatment,1 week after the operation in group A,there were 2 patients with grade I eye movement disorder and 18 patients without eye movement disorder.At 1 month after surgery,there was 1patient with grade I ocular movement disorder,and 19 patients had no ocular movement disorder.1 week after the operation in group B,there were 3patients with grade I eye movement disorder and 17 patients without eye movement disorder.At 1 month after the operation,there were 6 patients with grade I ocular movement disorder and 14 patients without ocular movement disorder.There were no patients with ocular movement disorder at 3 or 6months after surgery.Compared with Material can be absorbed(PLLA)and Medpor artificial bone in blowout orbital wall fracture caused by clear eye flesh,could lead to the data of eye movement disorder,found at 1 week of eye movement situation analysis of statistics show the differences between the results(Z =0.809,P>0.05),there is no obvious difference,not statistically significant;The results of the comparison and analysis of the eye movement of the patients 1month after surgery showed statistically significant differences(Z=-1.218,P<0.05),indicating that the absorbable materials were slightly heavier than before,which was considered to be related to the production of sterile inflammation during the absorbable materials absorption process.The situation was analyzed 3 or 6 months after surgery,and the difference was statistically significant(Z=-1.728,P>0.05),with no significant difference and no statistical significance.It was shown that the two materials were different in process due to the different mechanism of action of the two materials in the process of correcting the ocular movement disorder caused by the obvious incarceration of the eye muscle,but the two materials were not different in the end.4.All the patients had no visual impairment,wound infection,implant rejection,or displacement complications.Conclusion: In orbital blowout fracture reduction surgery,both use highdensity porous polyethylene(Medpor)and absorbable materials(PLLA)as implant materials,can effectively restore damaged orbital anatomy,correcting enophthalmos symptoms,patients with diplopia,and achieve obvious eye muscle of eye movement disorder,could lead to effective treatment,the curative effect is two kinds of material effectively,no more long-term outcome. |
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