基于眼球三维空间精确定位测量的外伤性眼眶缺损的个体化重建  

Personalized reconstruction of orbital defect based on the precise three-dimension orientation and measurement of eye socket

作　　者：黄立[1] 林李嵩[1] 王志红[2] 施斌[1] 朱小峰[1] 邱宇[1] 黄跃[1] 余学元[1] 廖云阳[1] 

机构地区：[1]福建医科大学附属第一医院口腔颌面外科,福建医科大学面部整复与重建研究室,福建福州350005 [2]福建医科大学数理计算机教学部,福建福州350004

出　　处：《中国口腔颌面外科杂志》2014年第2期136-143,共8页China Journal of Oral and Maxillofacial Surgery

基　　金：福建省自然科学基金(C0310015);福建省卫生厅青年科研基金(2010-1-16)~~

摘　　要：目的:探讨外伤性眼眶缺损损伤程度的精确评估以及个体化重建方法。方法 :对2003年7月—2012年6月间收治的97例外伤性眼眶缺损患者进行回顾性研究,患者手术前、后均进行螺旋CT扫描,采用眼球空间定位方法测量眼球的三维位置,计算眶容积的变化量,利用计算机辅助技术和快速原型技术制作个体化眶模型,进行模型外科,制订手术方案,并预制植入物和接骨板等。术中回纳疝出的眶内容物,植入预制的钛网、Medpor或其他植入物,精确重建缺损区的眶外形,恢复正常的眶和眶内容物的比例关系。根据术后外形、患者满意度、眼功能检查及CT检查结果评估疗效,分析并发症。结果:除1例患者面部外形欠满意,2例陈旧性患者眼球内陷矫正不佳,术后6个月复视仍无明显改善,2例术后轻度下睑外翻外,其余病例均取得满意疗效。缺损区的眶外形、眶及内容物的比例关系恢复满意,未发生明显并发症。结论:对外伤性眼眶缺损患者进行眼球三维空间位置、眶容积变化等损伤程度的精确数字化评估,通过个体化模型外科制定手术方案,早期手术,减少创伤,在恢复眶容积、维持和纠正眼球位置的同时精确重建眶壁解剖外形,可实现眶缺损个体化的重建,提高眶畸形整复效果。PURPOSE： To evaluated the methods for precise assessment of severity of traumatic orbital defect and techniques for customized reconstruction of orbital defect. METHODS： A retrospective study was conducted on 97 patients with traumatic orbital defect treated in our hospital from Jul. 2003 to Jun. 2012. Pre- and postoperative spiral computed tomography scans were available in all cases. Surgeons adapted a spatial location technique to measure the 3- dimensional position of the eyeball, followed by calculating the variation of orbital volume. Then the orbital model was fabricated utilizing computer-assisted design/manufacture and rapid prototyping technique to aid surgical planning and prefabricate implants and bone bonding plates. During surgery, surgeons fully exposed the orbital defect, then repositioned the herniated orbital contents and placed the prefabricated titanium mesh, Medpor or other implants to restore orbital morphology in the defect site and regain normal proportion between orbital walls and contents. The treatment outcome was evaluated in terms of postoperative appearance, patients＇ satisfaction, ophthalmologic examination and CT scans and un toward complications were analyzed postoperatively. RESULTS： Except unsatisfactory aesthetic result in 1 case, residual enophthalmos and diplopia with no significant improvement 6 months after surgery in 2 cases resulting from long-standing trauma, mild postoperative lower eyelid ectropion in 2 cases, the remaining patients were satisfactory with the results both in orbital morphology and proportion between orbital walls and contents with no overt complications. CONCLUSIONS： With the advantage of accurate digital evaluation on 3-dimensional position of the eyeballs and variation of orbital volume and customized modeling surgery, surgeons are capable of simulating surgery and carrying out early operation to minimize trauma and maintain or correct the position of eyeballs as well as reconstruct orbital defect anatomically so that customized reconstruct

关 键 词：个体化 眼眶骨折 重建 快速原型 

分 类 号：R779.1[医药卫生—眼科]