| Objective: The treatment of orbital fracture have been focusing on the reconstruction of orbital function and repairing of appearance, however, both of recover the function of bulbus oculi and reconstruction of orbital and craniomaxillofacial was a great challenge for ophthalmologists. At present, choose of repairing materials and surgical approach have been exploring in clinical setting. Along with the widespreadly utilize of imageology, manufacture and computer, and their combination in multiple area, computer-asisted prefabricated titanium mesh was gradually introduced to clinical. In the present study, we implanted computer.asisted prefabricated titanium mesh for overall repairing orbital wall and rim in complex orbital fracture patients, and explored its safety and efficacy.Methods:Total 47 patients (47eyes)with complex orbital fracture and a full medical history were enrolled from July 2007 to October 2010. The ratie of male and femal was 4.9:1, with 39 male (39 eyes) and 8 female (8 eyes). The age range was 13～54 years old, with the median was 34. The right and left eye was 20 and 27, respectively. All were injured before 2 weeks to 3 months, with the median was 4 weeks. The casues including 23 road accident (48.9%), 17 violence (36.2%), 4 fall (8.5%), 3 blast injury (6.4%). All of the patients with variable enophthalmos, limited ocular movement and diplopia, excepted 2 patients undergone eye ball enucleation, who were excluded for statistic.The peroid of followed-up was 6 months to 12months , with the median was 9 months.Patients were randomized into group A or B. The traditional way with Hydroxyapatite composite or Medpor for repairing orbital wall and Medpor for reconstructing orbital rim was used in group A patients; the normal anatomical structure was restored by copying the reversed mirror of the normal orbital wall as a substitute for the impaired one in group B patients, who were carried out spiral CT scan, which was the basis for 3D restruction of orbial wall via graph software. Preparing the defect orbital osseous structure 3D models using rapid prototyping, where tithanium mesh was formed by the computer aided , and then implanted the prefabricated titanium mesh during overall plastic surgery while repairing orbital wall and rim. The efficacy of computer.asisted prefabricated titanium mesh for complex orbital fracture was evaluated by postoperative measurements of diplopia figures and occult movement, and exophthalmos or changes of orbital capacity obtained by CT.Results:Some patients are followed Less than a year, so this paper only 6 months of follow.up those with each observation indexes.1 Ocular MovementNo differences between the two groups before operation (p>0.05). No inefficient or aggravation occurred in both groups after operation.In group A, 3 patients were cured, 22 were improvement after operation 2 weeks; 9 were cured, 16 were improvement after operation 3 months; 12 were cured, 13 were improvement after operation 6 months. There was statistically significant between all the time points pre- and post-operation (P<0.05), and between 2 weeks and 6 months after operation (χ~2=7.714,P<0.05), and no statistically significant(P>0.05) between 2 weeks and 3 months(χ~2=3.947),3 and 6 months after operation(χ~2=0.739).In group B, 6 patients were cured, 14 were improvement after operation 2 weeks; 11 were cured, 9 were improvement after operation 3 months; 16 were cured, 14 were improvement after operation 6 months. There was statistically significant between all the time points pre-and post-operation (P<0.05), and between 2 weeks and 6 months after operation (χ~2=10.101,P<0.05), and no statistically significant between 2 weeks and 3 months(χ~2=2.250), 3 and 6 months (χ~2=2.849)after operation (P>0.05).There was statistically significant between group A and B after operation 6 months (χ~2=4.840,P<0.05)。The cure rate in group B was greater than that in group A(cure rate B 80%,cure rate A 48% ).2 DiplopiaNo statistically significant between the two groups before operation (P>0.05). No inefficient and aggravation occurred in both groups after operation.In group A, 3 patients were cured, 22 were improvement after operation 2 weeks; 9 were cured, 16 were improvement after operation 3 months; 11 were cured, 14 were improvement after operation 6 months. There was statistically significant between 2 weeks and 6 months(χ~2=6.349)after operation (P<0.05), and no statistically significant between 2 weeks and 3 months(χ~2=3.947), 3 and 6 months(χ~2=0.333) after operation (P>0.05).In group B, 2 patients were cured, 18 were improvement after operation 2 weeks; 8 were cured, 12 were improvement after operation 3 months; 15 were cured, 5 were improvement after operation 6 months. There was statistically significant between 2 weeks and 6 months(χ~2=17.289) after operation (P<0.05), and no statistically significant between 2 weeks and 3 months(χ~2=4.800), 3 and 6 months (χ~2=5.013)after operation (P>0.05).There was statistically significant between group A and B after operation 6 months (χ~2=4.377 P<0.05). The cure rate in group B was greater than that in group A(Cure rate B 75%,Cure rate A 44%).3 Enophthalmos:No statistically significant between the two groups before operation (P>0.05). No inefficient and aggravation occurred in both groups after operation.In group A, 24 patients were cured, 1 were improvement after operation 2 weeks; 18 were cured, 7 were improvement after operation 3 months; 18 were cured, 7 were improvement after operation 6 months. There was statistically significant between 2 weeks and 3months (χ~2=5.357)after operation (P<0.05), and no statistically significant between 3 months and 6 months(χ~2=0.000,P>0.05).In group B, 19 patients were cured, 1 were improvement after operation 2 weeks, 3 and 6 months. There was no statistically significant between 2 weeks,3 months and 6 months(χ~2=0.000)after operation (P<0.05).There was statistically significant between group A and B after operation 3 months (χ~2=4.021 P<0.05). The cure rate in group B was greater than that in group A(Cure rate B 95%,Cure rate A 72%).4 Postoperative recovery of the injured side orbital capacity:No statistically significant on orbital capacity between the injured and normal side before operation (P>0.05).No statistically significant on orbital capacity between all the time points within group (P>0.05).The differences of orbital capacity between all the intervals within group is statistically significant (P<0.05), and group B is better than that in group A.Conclusion:1 Computer-assisted prefabricated titanium mesh introduced into the overall plastic surgery of complex orbital fracture, has advantages on restoring of ocular movement, diplopia, enophthalmos and orbital capacity compared with the traditional surgical approach.2 Ocular movements and diplopia still could be improved by exercises and time in 6 months after operation.3 Traditional restoration with enophthalmos will stable in three months or so. Computer-assisted prefabricated titanium mesh group were stable within 6 months, no significant change.
|
PDF Full Text Request