| Objective:The clinical effects of absorbable mesh plate and preformed titanium mesh plate in reconstruction of orbital blowout fracture were observed and compared.Method:From January 1,2015 to December 31,2018,the clinical data of 120 patients with blowout orbital wall fracture who were operated in our hospital ophthalmology department were analyzed retrospectively.Among them,40 patients received absorbable mesh plate implantation?observation group?,80 patients received preformed titanium mesh plate implantation?control group?.The best corrected visual acuity?BCVA?,eye movement,diplopia,exophthalmos,maxillofacial sensation and the safety of two groups were analyzed and evaluated before and after the operation.The differences between two groups at the same time point and the differences in one group at different time points were compared.Result:1.Vision:The preoperative and postoperative BCVA of observation group and control group were statistically analyzed,the results showed no significant difference(P observation group=0.311,P control group=0.357).There was no significant difference in preoperative and postoperative BCVA between two groups(P before operation=0.910,P after operation=0.892).Implantating different materials had no different effect on the visual acuity of the patients.2.Eye movement:Observation group:there were 25 patients with grade I eye movement disorder and no patients with grade II eye movement disorder before operation.One year after operation,two patients still had grade I eye movement disorder.The cured rate was 92%,and the ineffective rate was 8%.Control group:there were 58 patients with grade I eye movement disorder and 2 patients with grade II eye movement disorder before operation.One year after operation,eight patients had grade I eye movement disorder.The cured rate was 96.7%,the improved rate was 3.3%and the ineffective rate was 10%.The eye movements at before and after operation of observation group and control group were both have significant difference(P observation group=0.015,P control group=0.023).The eye movements of two groups were both had improved.There were 25?62.5%?patients with eye movement disorder in observation group and 60 patients?75%?with eye movement disorder in control group before operation.Two groups had significant difference?Z=-1.260,P=0.045?.3.Diplopia:Observation group:one year after operation,the cured rate was 67.7%,the effective rate was 22.6%and the ineffective rate was 9.7%.Control group:One year after operation,the cured rate was 58.6%,the effective rate was 31.4%and the ineffective rate was 10%.There was no significant difference in diplopia between two groups.The statistically significant results of each group before and after operation(P observation group=0.022,P control group=0.031)showed that different materials all could improve the symptoms of diplopia.4.Enophthalmos:Observation group:there were 5 patients with mild enophthalmos before operation,which were all improved in the early stage after operation.One patient had palindromic enophthalmos at six months after operation.Three patients had palindromic enophthalmos at twelve months after operation.Two of the three were less than before.The cured rate was 40%,the improved rate was 40%and the ineffective rate was 20%.Control group:there was one patient had moderate enophthalmos before operation and the exophthalmos was corrected from 5mm to 3mm after operation.There were 12 patients with mild enophthalmos before operation and 1 patient had palindromic enophthalmos at one year after operation.The cured rate was 76.9%,the improved rate was 15.4%and the ineffective rate was 7.7%.There was statistically significant difference between the two groups?Z=-0.135,P=0.046?.The palindromic enophthalmos rate of observation group was higher than control group.5.Maxillofacial sensation:There were 21 cases in observation group and 52 cases in control group with maxillofacial paresthesia before operation.One month after operation,the cured rate of observation group was 42.9%,the improved rate was57.1%.The cured rate of control group was 19.2%,and the improved rate was 80.8%.There was significant difference between the two groups??2=4.337,P=0.037?.There was no significant difference between the two groups at other time points after operation.6.Other complication:The time of chemosis after operation of two groups:the observation group was 3±1.34 days and the control group was 5±2.12 days.The difference was statistically significant?t=0.233,P=0.021?.In observation group,there was one patient with scar of lower eyelid skin caused by operation.In control group,there were 3 patients with epiphora after operation.There were no cases of blepharoptosis,abnormal position of lower eyelid,conjunctival sac constriction,implant rejection,implant displacement,and implant infection in both two groups.Conclusion:1.Absorbable mesh plate and preformed titanium mesh plate all could be used as good implant materials in blowout orbital fracture surgery,which can effectively repair orbital structure,improve eye movement and diplopia,correct enophthalmos,and relieve maxillofacial sensation disorder.2.In the long-term recurrence of enophthalmos after operation,absorbable mesh group was higher than titanium mesh plate group.3.In terms of the recovery of maxillofacial sensory abnormalities and the time of chemosis,the early effect of absorbable mesh plate group was better than preformed titanium mesh plate group. |
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