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目的:研究计算机辅助导航系统结合个体化三维钛网在复合性眼眶骨折治疗中的应用,并与传统手术方法进行比较,评价其治疗效果。方法:2008年10月-2010年12月在上海交通大学医学院附属第九人民医院口腔颌面外科和眼科联合治疗的陈旧性单侧眶颧骨折伴眼球内陷畸形病例64例,其中25例采用计算机辅助手术治疗以提高颧骨复位的准确性,术前眼球内陷平均5.71mm;39例采用传统方法治疗,术前眼球内陷平均4.96mm。眶重建中,35例采用钛网,12例采用聚乙烯聚合物(Medpor),5例采用羟基磷灰石板(HA),12例采用钛网+Medpor或HA。手术前后进行眼眶CT扫描、冠状和三维骨重建,术后评价颧骨复位和眼球内陷矫正效果。结果:计算机辅助治疗术后颧骨复位的满意率为92%,眼球突度满意率(≤2mm)为82%,轻度眼球内陷率(≤3mm)为17%。传统手术颧骨复位满意率为74%,眼球突度满意率为74%,轻度眼球内陷率(≤3mm)为19%,中度眼球内陷率(≤4mm)为6%。眼球突度满意率,单纯使用钛网为74%,联合材料为83%,Medpor为67%,HA为20%。结论:计算机辅助手术可提高陈旧性眶颧骨折伴眼球内陷畸形的治疗效果;钛网联合Medpor是治疗严重眼球内陷畸形的良好方法。
OBJECTIVE: To study the application of computer aided navigation system combined with personalized three-dimensional titanium mesh in the treatment of complex orbital fractures, and compared with traditional surgical methods to evaluate the therapeutic effect. METHODS: From October 2008 to December 2010, 64 patients with old unilateral orbital-zygomatic fracture and ocular retraction deformity underwent combined oral and maxillofacial surgery and ophthalmology in the Ninth People’s Hospital Affiliated to Shanghai Jiaotong University School of Medicine. Twenty-five of them Computer-assisted surgery to improve the accuracy of zygomatic reduction, preoperative ocular retraction average 5.71mm; 39 cases were treated by traditional methods, the average preoperative balloon retraction 4.96mm. In orbital reconstruction, 35 cases were treated with titanium mesh, 12 cases with polyethylene polymer (Medpor), 5 cases with hydroxyapatite plate (HA) and 12 cases with titanium mesh + Medpor or HA. Orbital CT scans before and after surgery, coronal and three-dimensional reconstruction of the bone, postoperative evaluation of zygomatic reduction and correction of the effect of eye retraction. Results: The satisfaction rate of cheekbones reduction after computer assisted surgery was 92%. The satisfactory rate of eyeball (≤2mm) was 82% and the rate of mild eyeball invagination (≤3mm) was 17%. The satisfaction rate of traditional surgery for cheekbones reduction was 74%, satisfaction rate of eyeballs was 74%, mild intracranial invagination (≤3mm) was 19%, and moderate subsidence (≤4mm) was 6%. Satisfaction rates were calculated using titanium mesh alone at 74%, composite at 83%, Medpor at 67% and HA at 20%. Conclusion: Computer-assisted surgery can improve the treatment effect of old orbital-zygomatic fracture with eyeball deformity. Titanium mesh combined with Medpor is a good method to treat severe ocular retraction deformity.