创伤性颅眶畸形的三维可视化诊断分析与手术整复  

Three-dimensional visualized diagnositics and reconstructive operation of traumatic cranio-orbital deformities

作　　者：杨斌[1] 沈伟[2] 洪清琦[1] 丘日升[1] 黄洪章[1] 祁佐良[3] 穆雄铮[3] 冯胜之[3] 王炜[3] 张涤生[3] 

机构地区：[1]中山大学颅颌面外科中心,广东广州510120 [2]中山大学电子系 [3]上海交通大学附属第九人民医院整复外科

出　　处：《中国美容医学》2007年第4期479-483,共5页Chinese Journal of Aesthetic Medicine

基　　金：广东省自然科学基金资助项目(编号:35120-4203185)

摘　　要：目的:依据颅眶创伤畸形诊断分类选择相应术式予以整复,并通过规范化治疗改善整复疗效。方法:81例创伤性颅眶畸形均经三维CT确诊为颅-眶-颧颌骨折和畸形。将其分为适合于选择手术术式的四类:①颅骨缺损;②眶壁爆裂骨折;③普通眶周骨折;④复杂眶周骨折。结果:①颅骨缺损12例(14.8%),采用自体肋骨或颅骨板移植获得良效;②眶壁爆裂骨折16例(19.7%),手术还纳眶内容、封闭疝孔、恢复眶腔容积和眼球位置;③普通眶周骨折21例(25.8%):以骨缺损形态体积相同的骨组织修复,无骨质缺损者则截骨,使骨折段复位固定;④复杂眶周骨折32例(39.5%):截断错位愈合的骨折线将眶-颧-颌复合体复位;眶粉碎者,应用CAD/CAM快速成型技术预制人工骨眶,手术效果良好。本组所有病例未出现植骨坏死、外露、畸形复发、眶内血肿等严重并发症。结论:颅骨缺损的整复仍以自体骨移植、钛网修复效果较好。眶爆裂骨折晚期畸形以植入自体骨或人工骨修复骨缺损、矫正复视、眼球复位为主。普通眶周骨折:采取截骨、植骨或生物材料植入修复的手术方案。复杂眶周骨折晚期畸形最有效的方法是截断错位愈合的骨折段,复位颅面骨结构形态。典型的LeFort型骨折,宜采用LeFortⅠ～Ⅲ型截骨手术。Objective To improve the reconstructive plastic effects through corresponding surgical treatments according to the classifications of traumatic deformities. Methods 81 cases of cranio-orbital deformities were treated. All the cases were diagnosed cranio -orbital-zygomatic-maxillary fractures and deformities through clinical examination and CT image analyses. All the cases were divided into 4 groups： Group 1. Skull defect：Group 2. Orbital blow-out fracture; Group 3.Ordinary orbital fracture;Group 4.Complicated orbital fracture. Results ① 12 cases （14.8%） with skull defect were underwent autogenous rib graft or outer lamellar skull bone implantation, and gained good effects. ②16 cases （19.7%）with orbital blow-out fracture were underwent operations to return orbital contents, recuperate orbital volume and eyeball position. ③21 cases （25.8%） with ordinary orbital fracture were repaired with bone tissues same volume of the defect parts, those without bone defects were underwent bone cutting and bones reposition. ④32 cases （39.5%） with complicated orbital fracture： The fracture line of malunion was resected and the orbital- zygomatic-maxillary complex was repositioned; In those with orbital pulverization, artificial hydroxyapatite bone orbital implant was prefabricated with CAD/CAM rapid prototype technology, and fine surgical effects were gained. No severe complications occurred in all the cases, such as osteonecrosis and revealment of implants, deformity recurrence and inter-orbital haematoma. Conclusion For skull defect, implantation with autogenous bone graft and titanium-meshwork will gain better effects. The treatment of the late stage deformities of orbital blow-out fracture will be focused on reconstructing bone defects with autogenous bone or biomaterials, rectifying diplopia and repositioning eyeball. For ordinary orbital fracture, the reparative operation will be completed through osteotomy , bone or biomaterials implanting. And for the late stage of complicated orbital fracture

关 键 词：创伤性颅眶畸形 三维诊断分析 整复手术 

分 类 号：R782.5[医药卫生—口腔医学]