| Purpose: To evaluate the clinical outcomes of blowout fractures repair using computer-assisted navigation system.Methods: The study involves 40 patients with blowout fractures,at the Second Hospital of Dalian Medical University from June,2017 to June,2018.The study was divided into two groups.One group consists of 20 patients who underwent navigation system procedure,and the other group consists of 20 patients who underwent convention method procedure.The comparative analysis was mainly based on visual acuity,orbital volumes,exophthalmos,diplopia,eye globe movement limitation and infra orbital numbness.Data were collected before surgery and six months after surgery.Results: In navigation group 14(70%)patients were male and 6(30%)patients were female,whereas with conventional group 12(60%)patients were male and 8(40%)patients were female.The range age in navigation group was 17-49(mean ± SD: 33.55 ± 8.04)and the range age in conventional group was 8-49(mean ± SD: 31.65 ± 10.95).The navigation group included 9(45%)patients with isolated orbital medial wall fractures,5(25%)patients with isolated orbital floor fractures and 6(30%)patients with combined orbital floor and medial wall fractures.Whilst in conventional group 9(45%)patients had isolated orbital floor fractures,4(20%)patients had isolated orbital medial wall fracture and 7(35%)patients had combined orbital floor and medial wall fractures.The etiology of the fractures in navigation group was aggression(10(50%)patients),fall(4(20%)patients)and traffic accident(6(30%)patients).With conventional group,the aggression was involved in 11(55%)patients,fall was involved in 7(35%)patients,traffic accident was involved in 1(5%)patient and sport-related fracture was involved in 1(05%)patient.In operated eyes,with navigation group 9(45%)were right eyes and 11(55%)were left eyes where in conventional group 4(20%)were right eyes and 16(80%)were left eye.In the navigation group there was no history of previous surgery but in conventional group 5(25%)of patients had surgery before;two patients had appendectomy surgery,one patient had rhinoplasty(nose surgery),one patient had arthroscopy(knee joint surgery)and one patient had C-section(cesarean surgery).The visual acuity before surgery is(mean ± SD: 0.71 ± 0.24)in the navigation group and(mean ± SD: 0.82 ± 0.19)in the conventional group.P= 0.13.At 6 months after surgery,in the navigation group,the visual acuity is(mean ± SD: 0.975 ± 0.05)and(mean ± SD: 0.96 ± 0.07)in the conventional group.P= 0.45.The evaluation of the visual acuity in both groups(navigation group and conventional group)at 6 months postoperatively showed that there were no statistically significance because P>0.05.This is mainly caused by a small sample size.The preoperative and postoperative mean difference of orbital volumes for navigation group is(mean ± SD in ml: 0.68 ± 0.29).The preoperative and postoperative mean difference of orbital volume for convention group is(mean ± SD in ml: 0.98 ± 0.22).These results showed a better outcomes of orbital volumes in navigation group than in convention group.Results are statistically significant since P= 0.03.In navigation group all 10 patients(100%)were fully corrected of enophthalmos postoperatively.In the conventional group postoperatively 1 out of 11 patients(90.91%)still have enophthalmos.Comparative analysis of exophthalmos between two groups showed that there were better amelioration in patients who underwent navigation system procedure than patients who underwent conventional method procedure.In navigation group(mean ± SD in mm: 0.81 ± 0.35).In convention group(mean ± SD in mm: 1.65 ± 0.37).These results were statistically significant because P= 0.01.Preoperative and postoperative diplopia outcomes showed that in navigation group 13 out of 14 patients(92.86%)were fully corrected postoperatively and in the conventional group 8 out of 10 patients(80%)were free of diplopia postoperatively.Although comparative analysis shows that postoperative diplopia outcome was better in navigation group than in conventional group postoperatively.In navigation group,13 out of 14 patients(92.86%)were free of eye globe movement limitation postoperatively.In conventional group postoperatively,8 out of 10 patients(80%)had no eye globe movement limitation.A comparative analysis showed that there were improvement of outcomes in navigation group more than in convention group postoperatively.In navigation group no patient(100%)had persistent infra orbital numbness postoperatively.In conventional group 6 out of 8 patients(75%)were free of infra orbital numbness postoperatively.We found better outcomes in navigation group than in convention group.In both groups there were no serious intraoperative or postoperative complications such as visual impairment or blindness.In both groups(navigation group and convention group)there were no need for the secondary operation.Normal vision,absence of entrapment,and globe symmetry were present in all patients(navigation group and conventional group)up to 6 months postoperatively.Conclusion:· The two types of surgeries have successfully and substantially improved theoutcomes of the visual acuity,of the orbital volumes,of the exophthalmos,of thediplopia,of the eye globe movement limitation,and of the infra orbital numbness.· A comparative analysis between two groups showed a more prominent outcomesamong the patients who underwent navigation system technique than those whounderwent conventional method technique· Our study showed that blowout fractures can be treated safely with navigationtechnique.In orbital surgery,navigation system improves better outcomes.Navigation system makes possible to design preoperative plan accurately withoutinjury and confirm the position of the instruments on the surgical site in real time. |
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