三维打印联合手术导航及内镜在眼眶骨折整复术中的应用  

Application of three?dimensional printing combined with surgical navigation and endoscopy in orbital fracture reconstruction

作　　者：廖洪斐[1] 余进海 胡长青[2] 胡小燕 刘茜[1] 王耀华[1] 王安安[1] 徐柒华[1] Liao Hongfei;Yu Jinhai;Hu Changqing;Hu Xiaoyan;Liu Qian;Wang Yaohua;Wang Anan;Xu Qihua(Affiliated Eye Hospital of Nanchang University,Jiangxi Research Institute of Ophthalmology & Visual Sciences,Nanchang 330006,China;Department of Ophthalmology,Ganzhou People′s Hospital of Jiangxi Province,Ganzhou 341000,China;People′s Hospital of Qianshan County,Shangrao City,Jiangxi Province,Shangrao 334500,China)

机构地区：[1]南昌大学附属眼科医院江西省眼科学重点实验室,330006 [2]江西省赣州市人民医院眼科,341000 [3]江西省上饶市铅山县人民医院眼科,33450000

出　　处：《中华眼科杂志》2019年第9期658-664,共7页Chinese Journal of Ophthalmology

基　　金：江西省科技厅重点研发计划(20171BBG70096,20181BBG70007);江西省自然科学基金(20181BAB205035).

摘　　要：目的评价三维打印联合手术导航及内镜应用于眼眶骨折整复术的临床效果.方法系列病例研究.收集2016年7月至2018年6月间在南昌大学附属眼科医院就诊的28例(28只眼)眼眶骨折患者(男性20例,女性8例,年龄在10~61岁,单纯性眼眶骨折22例,复合性眼眶骨折6例)行三维打印联合手术导航及内镜进行眼眶骨折整复术治疗.借助三维打印的模型与导板、导航的定位引导和内镜下的可视化性能,通过松解眼眶骨折区域嵌顿的软组织并植入修复材料以完成骨折整复(附视频).术后1周、3个月随访观察最佳矫正视力、复视、眼球运动障碍、眼球内陷和眼眶容积等改善情况.采用配对t检验、Wilcoxon符号秩检验、Mann-Whitney U秩和检验进行统计学分析.结果 28例患者28只患眼术前与术后1周最佳矫正视力分别为4.714±0.400和4.732±0.377,差异无统计学意义(t=1.724,P=0.096);术前与术后1周双眼眼球内陷差值分别为2.2(2.0~5.0)、0.3(0.0~2.3)mm,眼眶容积差值分别为2008.10(6.84~11200.00)、478.76(5.01~7286.00)mm^3,术后较术前均显著减小,差异均有统计学意义(Z=-4.604、-3.735,均P<0.01).术后3个月复视程度较术前明显改善(术前复视程度为0、Ⅰ、Ⅱ、Ⅲ级分别有14、11、3、0只眼,术后复视程度为0、Ⅰ、Ⅱ、Ⅲ级分别有22、6、0、0只眼),差异有统计学意义(Z=-2.359,P=0.018);眼球运动障碍情况较术前明显好转(术前眼球运动障碍为0、Ⅰ、Ⅱ、Ⅲ级分别有11、11、3、3只眼,术后眼球运动障碍为0、Ⅰ、Ⅱ、Ⅲ级分别有23、5、0、0只眼),差异有统计学意义(Z=-3.456,P=0.001).术后随访3~12个月未发现植入物感染、移位和其他严重并发症.结论三维打印联合手术导航及内镜应用于眼眶骨折整复术可明显改善患者复视、眼球运动障碍和眼球凹陷症状,是一个可行的辅助方法.Objective To evaluate the clinical effect of three-dimensional printing combined with surgical navigation and endoscopy for orbital fracture reconstruction. Methods A case series study. Twenty-eight patients (28 eyes) with orbital fractures (20 males and 8 females, aged 10-61 years, with simple orbital fractures in 22 patients and composite orbital fractures in 6 patients) were treated with three-dimensional printing combined with surgical navigation and endoscopy for orbital fracture reconstruction at Affiliated Eye Hospital of Nanchang University from July 2016 to June 2018. With the help of three-dimensional printed models and guides, navigation positioning guidance and endoscopic visualization performance, the soft tissue incarcerated in the orbital fracture area was loosened, and the repair material was implanted (video attached). Postoperative follow-up was conducted at 1 week and 3 months. The follow-up observation included the best corrected visual acuity, diplopia, dyskinesia of the eyes, enophthalmos, and orbital volume. The data were analyzed by the paired t-test, Wilcoxon and the Mann-Whitney U rank sum test. Results The best corrected visual acuity before and 1 week after surgery was 4.714±0.400 and 4.732±0.377, respectively, and the difference was not statistically significant (t=1.724, P=0.096). The enophthalmos before and 1 week after surgery was 2.2 (2.0-5.0) mm and 0.3 (0.0-2.3) mm, respectively, and the difference was significant (Z=-4.604, P<0.01). The orbital volume before and 1 week after surgery was 2008.10 (6.84-11200.00) mm^3 and 478.76 (5.01-7286.00) mm^3, respectively, and the difference was statistically significant (Z=-3.735, P<0.01).The preoperative diplopia degree was 0,Ⅰ,Ⅱ, and Ⅲ in 14, 11, 3, and 0 eyes, while the degree of diplopia 3 months after surgery was 0,Ⅰ,Ⅱ, and Ⅲ in 22, 6, 0, and 0 eyes, respectively. The difference was statistically significant (Z=- 2.359, P=0.018). The preoperative dyskinesia degree of the eyes was 0,Ⅰ,Ⅱ, and Ⅲ in 11, 11, 3, and 3 ey

关 键 词：眶骨折 打印 三维 外科手术 计算机辅助 内窥镜检查 修复外科手术 

分 类 号：R779.6[医药卫生—眼科]