眶颅骨纤维异常增殖症病灶手术切除与缺损区钛金属修复  

Resection of orbito-cranial fibrous dysplasia lesion and reconstruction with titanium

作　　者：许蓓[1] 马建荣[2] 易文殊 谭佳[1] 向前[1] 许雪亮[1] 

机构地区：[1]中南大学湘雅医院眼科,长沙410008 [2]中南大学湘雅医院神经外科,长沙410008 [3]福建武警总队医院眼科,福州350003

出　　处：《中南大学学报（医学版）》2012年第3期267-270,共4页Journal of Central South University ：Medical Science

摘　　要：目的：研究眶颅骨纤维异常增殖症手术切除病灶的时机和方法，总结病灶切除后钛金属修复骨缺损的经验，对手术的疗效进行评估。方法：对21例出现视功能障碍或明显外观影响的患者进行术前常规冠状位、水平位、矢状位及三维CT扫描。对眶颅骨病变范围大的患者，将CT扫描图像数据输入计算机，经过处理后制作钛金属三维实体修复体；对于累及眶颅骨病变范围较小的患者，则用手工的方法在手术中制作近似于正常眼眶和颅骨部的修复体。全部病例均采用经颅手术切除病变骨组织，并用钛板和钛网修复缺损区。结果：2l例患者中18例一次性切除干净，3例累及海绵窦区域者进行姑息性切除。13例伴有不同程度的视力下降，11例术后视力明显上升，视力恢复在3-5行。外观畸形的11例患者术后得到明显改善。结论：眶颅骨纤维异常增殖症患者只要影响到视功能或造成眶颅外观畸形，应该尽早进行手术切除。钛金属修复手术后遗留的骨缺损具有牢固、可塑性强、固定简易等优点。Objective： To discuss the method and opportunity of operation for orbito-cranial fibrous dysplasia, and further to summarize our experience in repairing the bony defect with titanium after excision and assess the surgical outcomes. Methods： A retrospective study was performed in 21 patients with visual function damage and/ or orbital malformation, who treated surgically. All patients were underwent CT examinations （coronal, horizontal, sagittal and three-dimensional scans） before surgery. CT image data of patients with serious orbital skull lesions were analyzed by computer to produce the three-dimensional, solid titanium mesh prostheses used to repair the lesions; for smaller lesions solid titanium mesh prostheses were shaped artificially during surgery according to the normal orbit and the cranium. All the patients were treated surgically via craniofacial approach. After removing the diseased tissue, the defective area was repaired by titanium plate and nets. Results： Of the 21 patients, tumor removal was complete in 18 patients, and incomplete in 3 patients due to extensive invasion into the sious cavernosus. Of the 13 patients with vision impairment before surgery, vision was improved in 11 cases （range from 3 to S lines） following surgery. All orbital malformations were healed in these 11 patients. Conclusion： Patients with fibrous dysplasia should undergo surgical treatment as soon as possible. Where this results in visual dysfunction or orbital-cranial deformities, repairing the bony defect with titanium material has many advantages： it is solid, easily molded, and easily fastened.

关 键 词：眶颅 骨纤维异常增殖症 手术治疗 钛金属修复 

分 类 号：R651.1[医药卫生—外科学]