外伤性眶颧部骨折治疗50例临床分析

目的探讨根据不同的损伤类型及程度，选择性运用眶周截骨术及眶内充填术，对50例眶颧部骨折患者的整复治疗效果。方法根据眶颧部骨折的不同损伤程度，采用眶壁眶缘截骨术，恢复眼眶的解剖结构，并根据骨块复位程度．选用自体或医用材料进行眶周和眶内骨膜下充填，修复眼眶。结果50例患者术后双侧眼球突出度、面中部对称性，宽度等均较手术前有明显改善。本组有2例长期复视，5例术后有轻度眼球凹陷。结论眶周截骨复位术，辅助选用眶内材料充填可以有效矫正陈旧性眶颧部骨折畸形。     

陈旧性眶颧骨折合并眼球内陷的治疗

目的：探讨陈旧性眶颧骨折后眼球内陷的整复治疗。方法：术前常规行x线检查、眶部轴面及冠状位扫描及三维重建,了解眶颧骨骨折及眶内容物移位嵌顿情况。术中首先暴露骨折部位,将移位的骨折块截骨复位、微型钛板坚强内固定,重建正常的眶缘;用自体或人工材料植入,同时修复眶壁。结果：所有病例眼球内陷均得以明显改善或矫正,颧部外形明显改善,眼球运动功能得以恢复,CT显示眶结构恢复良好,内直肌及下直肌位置及形态正常,视神经无受压。结论：陈旧性眶颧骨折所致晚期眼球内陷畸形可通过截骨复位、植入自体或人工材料重建眶缘,修复眶骨各壁的缺损获得有效矫正。     

眶骨骨折眼球移位的矫正

目的：探索矫正眶周外伤，肿瘤造成的眶骨骨折眼球移位的有效安全的手术方法。方法：截骨或去除挤占正常眼球位置的碎骨块或肿瘤组织，给眼球复位提供空间，于眼球复位后所出现的空间植骨或置入组织代用品，采用此种手术方法进行眶周肿瘤切除眼球复位2例，各种原因外伤导致的眶上壁，眶内侧壁，眶下壁骨折眼球移位复位4例，结果：2例肿瘤患者均为良性向眶内生长的占位性病变，手术完整切除，眼球位置恢复正常。4例外伤骨折中的1例内眦韧带附着处骨折，内眦韧带复位不佳，余3位术后效果满意。结论：眼眶，眼球移位修复是较为困难的课题，我们介绍的手术方法实用可靠。     

三维眶底重建钛网修复复合性眼眶骨折患者的护理

目的总结三维眶底重建钛网治疗复合性眼眶骨折患者围术期的护理经验。方法对19例复合性眼眶骨折患者植入三维眶底重建钛网修复骨折缺损,同时给予针对性护理和定期随访。结果术后随访6～10个月,15例眼球内陷矫正,4例眼球内陷改善;17例眼球下移完全矫正,2例残留眼球下移1.0mm;12例眼球运动受限完全矫正,7例眼球运动障碍减轻;19例患者手术前后视力均无明显改变。随访期间未出现眶内感染、眶内血肿、视神经损伤、钛网排斥和移位等并发症。CT显示钛网重建骨壁位置与健侧骨壁对称。结论术前做好患者沟通和教育,术后密切观察病情,预防各种并发症,出院后加强术眼自我护理及功能锻炼,对确保治疗效果至关重要。     

分块截骨复位术治疗陈旧性眶颧骨折错位愈合畸形

目的 探讨眶颧外伤后严重错位畸形的手术矫正方法。方法 眶颧分块截骨，将眶外下截骨块向内上移位固定，将颧突颧弓块向外上提升固定。结果 治疗22例，眶外下缘向内、向上平均移位各8．1mm，颧突向上向外平均提升9．2mm并平均内旋1．5mm。平均随访6个半月，无明显复发，外形良好。结论 眶颧分块截骨异向提升术可以有效地治疗严重眶颧外伤后错位畸形。     

获得性眶骨畸形与缺损的整复

目的 探讨获得性眶骨畸形的修复重建方法.方法 采用头皮冠(半冠)状切口、下脸睫毛缘下切口以及口内龈颊沟切口入路,个别患者采用眶周原有的瘢痕做切口,对眶壁骨组织进行截骨复位,或移植下颌骨外板修复眶骨缺损,以完成眼眶完整性的重建.结果 2002年9月至2006年6月,共治疗64例获得性眶骨畸形,术后患者恢复了正常的眼眶结构和眼球位置,无严重并发症发生.结论 获得性眶骨畸形的治疗应以恢复眼眶的完整性为重要治疗目标,以截骨复位矫正眶周畸形、自体下颌骨外板为材料修复骨缺损,有较好的临床治疗效果.     

创伤性颅眶畸形的三维可视化诊断分析与手术整复

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Le Fort型骨折，宜采用Le FortⅠ～Ⅲ型截骨手术。     

眶骨骨折继发眼球内陷的外科治疗

目的　对眶骨骨折进行分类 ,明确导致眼球内陷的原因并采取相应的手术治疗 ,提高眼球内陷畸形的手术矫治效果。方法　所有患者术前常规X线片、眶部轴面及冠面CT检查。根据检查结果 ,将眶骨骨折主要分为两型 :Ⅰ .单纯眶壁骨折 ,眶缘完整。此类骨折的部位主要发生在骨壁薄弱的眶底及眶内壁。Ⅱ .构成眶骨的骨骼骨折移位造成的眶骨的破裂。多见于眶颧骨折和鼻筛眶骨折。对Ⅰ型骨折所导致的眼球内陷畸形经下睑睫毛缘下切口入路 ,采用自体骨或人工骨材料置入修复 ;Ⅱ型骨折所造成的眼球内陷首先将移位的骨折块截骨复位、小夹板坚强内固定 ,重建正常的眶缘并采用自体或人工材料置入同时修复眶壁。结果　自 1996年 7月 - 2 0 0 0年 10月 ,共治疗眼球内陷畸形患者 5 2例 ,其中Ⅰ型 10例 ,Ⅱ型4 2例。眼球内陷畸形均明显矫正。结论　眶骨骨折所造成的后期眼球内陷畸形主要是因为眶骨骨性容积增大所造成的眶内容物与眶骨骨性容积失衡的结果 ,可通过植骨的手段修复眶骨各壁的缺损、缩小扩大的眶腔、重建眶骨正常的解剖形态和眶容积而得以有效的矫正。     

Perioperative care of patients with compound fracture of the orbit managed with three-dimensional reconstruction of the orbital floor by using titanium mesh

目的 总结三维眶底重建钛网治疗复合性眼眶骨折患者围术期的护理经验.方法 对19例复合性眼眶骨折患者植入三维眶底重建钛网修复骨折缺损,同时给予针对性护理和定期随访.结果 术后随访6～10个月,15例眼球内陷矫正,4例眼球内陷改善;17例眼球下移完全矫正,2例残留眼球下移1.0 mm;12例眼球运动受限完全矫正,7例眼球运动障碍减轻;19例患者手术前后视力均无明显改变.随访期间未出现眶内感染、眶内血肿、视神经损伤、钛网排斥和移位等并发症.CT显示钛网重建骨壁位置与健侧骨壁对称.结论 术前做好患者沟通和教育,术后密切观察病情,预防各种并发症,出院后加强术眼自我护理及功能锻炼,对确保治疗效果至关重要.     

经泪阜入路修复眼眶内侧壁骨折后眼球内陷

目的探讨经泪阜人路修复眼眶内侧壁骨折后眼球内陷的手术方法和疗效。方法2004年9月至2010年3月,收治36例眼眶内侧壁骨折眼球内陷患者。根据术前眼眶水平位及冠状位CT检查,确认眶骨骨折及眶内容物移位情况。术中经泪阜人路修复眼眶内侧壁骨折后的眼球内陷。结果术后除5例改善不明显外,其余患者眼球内陷畸形均获明显改善,皮肤面不遗留手术切口瘢痕。术后患者均获随访,随访时间1年。结论经泪阜人路修复眼眶内侧壁骨折所致眼球内陷,比传统方法更加快捷,术后患者外形更美观。     

Quantification of increased exposure resulting from orbital rim and orbitozygomatic osteotomy via the frontotemporal transsylvian approach

OBJECT: Use of orbital rim and orbitozygomatic osteotomy has been extensively reported to increase exposure in neurosurgical procedures. However, there have been few attempts to quantify the extent of additional exposure gained by these maneuvers. Using a novel laboratory technique, the authors have attempted to measure the increase in the "area of exposure" that is gained by removal of the orbital rim and zygomatic arch via the frontotemporal transsylvian approach. METHODS: The authors dissected five cadavers bilaterally. The area of exposure provided by the frontotemporal transsylvian approach was determined by using a frameless stereotactic device. With the tip of a microdissector placed on targets deep within the exposure, the position of the end of the microdissector handle was measured in three-dimensional space as the microdissector was rotated around the periphery of the operative field. This maneuver was performed via the frontotemporal approach alone as well as with orbital rim and orbitozygomatic osteotomy approaches. After data manipulation, the areas of exposure corresponding to the polygons used to define these handle positions were calculated and directly compared. On average, the area of exposure provided by the frontotemporal transsylvian approach was increased 26 to 39% (p<0.05) by adding orbital rim osteotomy and an additional 13 to 22% (not significant) with removal of the zygomatic arch. CONCLUSIONS: Significant and consistent increases in surgical exposure were obtained by using orbital osteotomy, whereas zygomatic arch removal produced less consistent gains. Both maneuvers may be expected to improve surgical access. However, because larger and more consistent gains were afforded by orbital rim removal, the threshold for removal of this portion of the orbitozygomatic complex should be lower.     

眶颧骨瓣改良成形术的解剖学研究

目的对眶颧入路进行解剖学研究,探索一种新的眶颧骨瓣成形方法。方法 6例12侧灌注尸头采用改良后的眶颧骨瓣成形术,形成两块骨瓣式眶颧入路。结果本组12侧暴露效果好,操作简单,改良后的眶颧骨瓣成形术,没有骨质丢失,眶顶重建效果好。结论改良后的眶颧骨瓣成形术通过运用关键孔和3号孔降低了眶颧入路的难度,创伤小。     

Lateral Orbital Rim Osteotomy in the Treatment of Certain Skull Base Lesions

Quantitative data from a recent human cadaveric study suggested that removal of the lateral orbital rim alone may be sufficient to reach many targets for which the orbitozygomatic craniotomy has been used. Consequently, a lateral orbital rim osteotomy was substituted for an orbitozygomatic craniotomy in seven patients with a variety of pathologies located in the anterior, middle, and interpeduncular fossae. In each case, lateral orbitotomy provided a satisfactory surgical corridor for diagnosis and treatment. Compared with the orbitozygomatic craniotomy, the lateral orbital rim osteotomy offers several advantages: technical simplicity, shorter operating time, and a low risk of postoperative malocclusion. If, however, prolonged access to a wide expanse of the anterior portion of the middle fossa and inferotemporal area is needed, an orbitozygomatic approach is a better choice.     

Orbitozygomatic approach by transposition of temporalis muscle and one-piece osteotomy.

BACKGROUND: A more simplified and easier technique for the orbitozygomatic approach is sought. We have developed a new modification to fully expose the temporal base before using one-piece craniotomy. METHODS: By transposing the temporalis muscle underneath the zygomatic arch before osteotomy, the temporal base and the inferior orbital fissure can be fully exposed. Craniotomy is made in one piece with the frontotemporal and orbitozygomatic bone together by using a high-speed drill. RESULTS AND CONCLUSIONS: Osteotomy was easy and the cosmetic result was satisfactory. This technique also allows better access to the subtemporal region without removing the zygomatic arch.     

应用三维头模及定位钛板矫治单侧复杂眶颧骨折继发畸形

目的 对应用三维头模及定位钛板矫治单侧复杂眶颧骨折继发畸形这一方法 及其疗效进行总结和探讨.方法 术前对所有患者行薄断层CT检查,获取DICOM数据,应用快速成型技术制作患者的原始三维头模和经镜像处理后的三维头模.在原始三维头模上进行健、患侧对比、分析和测量,然后在经镜像处理后的三维头模上弯制定位钛板.术中在定位钛板引导下截骨复位颧骨颧弓,并进行眶壁重建和植骨.结果 2007年3月至2009年2月,于临床应用7例,手术过程顺利.术后1周CT检查,患侧颧骨颧弓的位置和外形与健侧基本对称,无术后感染、植入物移位等并发症.7例中有3例术后3个月进行了复查,2例面部外形基本对称,1例颧面部出现瘢痕挛缩,颞区软组织萎缩,需行二期软组织整复.结论 应用三维头模制作术中定位钛板,引导治疗单侧复杂眶颧骨折继发畸形,方法 简单,临床效果可靠.     

应用三维头模及定位钛板矫治单侧复杂眶颧骨折继发畸形

目的 对应用三维头模及定位钛板矫治单侧复杂眶颧骨折继发畸形这一方法 及其疗效进行总结和探讨.方法 术前对所有患者行薄断层CT检查,获取DICOM数据,应用快速成型技术制作患者的原始三维头模和经镜像处理后的三维头模.在原始三维头模上进行健、患侧对比、分析和测量,然后在经镜像处理后的三维头模上弯制定位钛板.术中在定位钛板引导下截骨复位颧骨颧弓,并进行眶壁重建和植骨.结果 2007年3月至2009年2月,于临床应用7例,手术过程顺利.术后1周CT检查,患侧颧骨颧弓的位置和外形与健侧基本对称,无术后感染、植入物移位等并发症.7例中有3例术后3个月进行了复查,2例面部外形基本对称,1例颧面部出现瘢痕挛缩,颞区软组织萎缩,需行二期软组织整复.结论 应用三维头模制作术中定位钛板,引导治疗单侧复杂眶颧骨折继发畸形,方法 简单,临床效果可靠.     

高密度多孔聚乙烯在眶颧骨折继发畸形修复重建术中的应用

目的　探讨高密度多孔聚乙烯材料在眶颧骨折继发畸形修复重建术中的应用。方法　首先将骨折移位的眶颧骨截骨复位并进行可靠的内固定 ,采用高密度多孔聚乙烯材料准确修复眶壁及骨缺损区。结果　自 2 0 0 0年1月至 2 0 0 1年 12月 ,共收治眶颧骨折 2 0例。术后扩大的眶容积通过截骨复位及眶壁修复已缩小 ,眶下缘抬高至对侧水平 ,眼球内陷矫正或有明显改善 ,复视消失或减轻 ,面部畸形明显改善。结论　高密度多孔聚乙烯材料具有良好的生物相容性 ,其内部微孔有利于邻近纤维组织长入 ,易于雕刻塑形 ,可替代自体骨用于眶骨缺损及颧上颌区凹陷畸形的填充修复     

应用三维头模及定位钛板矫治单侧复杂眶颧骨折继发畸形

目的 对应用三维头模及定位钛板矫治单侧复杂眶颧骨折继发畸形这一方法 及其疗效进行总结和探讨.方法 术前对所有患者行薄断层CT检查,获取DICOM数据,应用快速成型技术制作患者的原始三维头模和经镜像处理后的三维头模.在原始三维头模上进行健、患侧对比、分析和测量,然后在经镜像处理后的三维头模上弯制定位钛板.术中在定位钛板引导下截骨复位颧骨颧弓,并进行眶壁重建和植骨.结果 2007年3月至2009年2月,于临床应用7例,手术过程顺利.术后1周CT检查,患侧颧骨颧弓的位置和外形与健侧基本对称,无术后感染、植入物移位等并发症.7例中有3例术后3个月进行了复查,2例面部外形基本对称,1例颧面部出现瘢痕挛缩,颞区软组织萎缩,需行二期软组织整复.结论 应用三维头模制作术中定位钛板,引导治疗单侧复杂眶颧骨折继发畸形,方法 简单,临床效果可靠.

Abstract：

Objective To discuss the application of 3-D skull models and guide plates in treatment of unilateral orbitozygomatic deformity after fracture. Methods Each patient underwent CT scan and DICOM data was obtained preoperatively. Two 3-D resin skull models were produced by rapid prototyping technique. The first model was produced based on the patient' s original data and the second was the reshaped model by mirroring the unaffected facial side to the traumatic side. The original model was used for measurement of the fracture displacement in three directions and model surgery. On the second model, one 2.0 mm miniplate (Synthes Inc) was bended along the orbital rim as the repositioning guide plate. During the operation, osteotomy and reduction of zygomatic and the periorbital fractures was guided by prepared repositioning guide plate, following by orbital wall reconstruction and bone grafting. Results From March 2007 to February 2009, 7 cases (6 males and 1 female) were treated successfully with no infection or graft extrusion. One week after operation, the patient received CT examination again. The shape and location of zygomatic bone and arch was good. Three cases were followed up for 3 months.Among them, facial symmetry was achieved in 2 cases. Cicatricial contracture and temporal soft tissue atrophy occurred in one case. Conclusions Reliable therapeutic effect can be achieved by application of rapid prototyping technique and repositioning guide plate in the treatment of complicated posttraumatic orbitozygomatic deformity.