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

中国口腔颌面外科杂志 ›› 2014, Vol. 12 ›› Issue (2): 136-143.

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

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

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

收稿日期:2013-10-11 修回日期:2014-01-21 出版日期:2014-03-10 发布日期:2014-11-06
通讯作者: 林李嵩, 13905006502,E-mail: dr_lls@163.com
作者简介:黄立(1976-),男,硕士,主治医师,E-mail: huangli_1222@163.com
基金资助:
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)

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

HUANG Li¹, LIN Li-song¹, WANG Zhi-hong², SHI Bin¹, ZHU Xiao-feng¹, QIU Yu¹, HUANG Yue¹, YU Xue-yuan¹, LIAO Yun-yang¹

1.Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital, Fujian Medical University, Fujian Medical University Research Institute of Facial Restoration and Reconstruction. Fuzhou 350005;
2.Fujian Medical University Research Department of Mathematics Physical and Computer. Fuzhou 350004, Fujian Province, China

Received:2013-10-11 Revised:2014-01-21 Online:2014-03-10 Published:2014-11-06
Supported by:
Supported by Natural Science Foundation of Fujian Province (C0310015); Youth Research Foundation of Health Department of Fujian Province(2010-1-16).

摘要/Abstract

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。

关键词: 个体化, 眼眶骨折, 重建, 快速原型

Abstract: 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 untoward 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 reconstruction of orbital defect is achieved and efficacy thereof is guaranteed.

Key words: Personalization, Orbit fracture, Reconstruction, Rapid prototyping

中图分类号:

R782.4

黄立, 林李嵩, 王志红, 施斌, 朱小峰, 邱宇, 黄跃, 余学元, 廖云阳. 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[J]. 中国口腔颌面外科杂志, 2014, 12(2): 136-143.

HUANG Li, LIN Li-song, WANG Zhi-hong, SHI Bin, ZHU Xiao-feng, QIU Yu, HUANG Yue, YU Xue-yuan, LIAO Yun-yang. Personalized reconstruction of orbital defect based on the precise three-dimension orientation and measurement of eye socket[J]. China J Oral Maxillofac Surg, 2014, 12(2): 136-143.

参考文献

[1] 王炜. 眼部整形美容的现状和前景[J]. 实用美容整形外科杂志, 2002, 13(1): 1-2.
[2] Howard G, Osguthorpe JD. Concepts in orbital reconstruction [J]. Otolaryngol Clin North Am, 1997, 30(4): 541-562.
[3] Thorne CH著,郭树忠译.格·斯整形外科学 [M]. 西安: 世界图书出版社公司, 2002: 363-404.
[4] Cole P, Kaufman Y, Hollier L. Principles of facial trauma: orbital fracture management [J]. J Craniofac Surg, 2009, 20(1): 101-104.
[5] Nkenke E, Maier T, Benz M, et al. Hertel exophthalmometry versus computed tomography and optical 3D imaging for the determination of the globe position in zygomatic fractures [J]. Int J Oral Maxillofac Surg, 2004, 33(2): 125-133.
[6] 何冬梅, 张益, 张震康, 等.三维头颅模型在口腔颌面外科的应用 [J].中华口腔医学杂志, 2001, 36(5): 334-337.
[7] Korves B, Klimek L, Klein HM, et al. Image- and model-based surgical planning in otolaryngology[J]. J Otolaryngol, 1995, 24(5): 265-270.
[8] 周树夏, 刘彦普. 进一步提高面中部骨折的治疗质量 [J]. 中华口腔医学杂志, 2004, 39(1): 2-4.
[9] 焦婷, 张富强, 孙健. 计算机辅助设计颌面缺损修复技术的开发应用研究 [J]. 中华口腔医学杂志, 2004, 39(2): 129-132.
[10] Holck DE, Boyd EM Jr, Ng J, et al. Benefits of stereolithography in orbital reconstruction[J]. Ophthalmology,1999,106(6):1214-1218.
[11] Choi JY, Choi JH, Kim NK, et al. Analysis of errors in medical rapid prototyping model[J]. Int J Oral Maxillofac Surg,2002,31(1): 23-32.
[12] Gordon CR, Susarla SM, Yaremchuk MJ. Quantitative assessment of medial orbit fracture repair using computer-designed anatomical plates[J]. Plast Reconstr Surg,2012, 130(5): 698e-705.
[13] Yi WS, Xu XL, Ma JR, et al. Reconstruction of complex orbital fracture with titanium implants [J]. Int J Ophthalmol, 2012, 5(4): 488-492.
[14] 何冬梅, 李政康, 范先群, 等. 计算机辅助导航系统和个体化三维钛网在陈旧性眶颧骨折治疗中的应用 [J]. 中国口腔颌面外科杂志, 2011, 9(2): 143-150.
[15] 王志红,林李嵩,黄立,等. 眼球三维空间定位测量法的建立 [J]. 福建医科大学学报, 2005, 39(3): 319-323.
[16] 林李嵩, 王炜, 王志红, 等. 建立个性化眶三维模型的研究 [J]. 中华整形外科杂志, 2006, 22(2): 95-98.
[17] Hwang K, You SH, Sohn IA. Analysis of orbital bone fracture: a 12-year study of 391 patients [J]. J Craniofac Surg, 2009, 20(4): 1218-1223.
[18] Nam SB, Bae YC, Moon JS, et al. Analysis of the postoperative outcome in 405 cases of orbital fracture using 2 synthetic orbital implants [J]. Ann Plast Surg, 2006, 56(3): 263-267.
[19] Eski M, Sahin I, Deveci M, et al. A retrospective analysis of 101 zygomatico-orbital fractures [J]. J Craniofac Surg, 2006, 17(6): 1059-1064.
[20] Obuekwe O, Owotade F, Osaiyuwu O. Etiology and pattern of zygomatic complex fractures: a retrospective study [J]. J Natl med Assoc, 2005, 97(7): 992-996.
[21] 范先群, 沈勤, 李海生, 等. 眼眶爆裂性骨折伴眼球内陷的眼眶容积测量 [J]. 中华眼科杂志, 2002, 38(1): 39-41.
[22] Lee H, Ahn J, Lee TE, et al. Clinical characteristics and treatment of blow-out fracture accompanied by canalicular laceration [J]. J Craniofac Surg, 2012, 23(5): 1399-1403.
[23] 范先群, 施沃栋. 计算机辅助技术在眼眶骨折修复手术中的应用 [J]. 中国眼耳鼻喉科杂志, 2009, 9(6): 344-346.
[24] Sanno T, Tahara S, Nomura T, et al. Endoscopic endonasal reduction for blowout fracture of the medial orbital wall [J]. Plast Reconstr Surg, 2003, 112(5): 1228-1237.
[25] Fernandes R, Fattahi T, Steinberg B, et al. Endoscopic repair of isolated orbital floor fracture with implant placement [J]. J Oral Maxillofac Surg, 2007, 65(8): 1449-1453.
[26] Garibaldi DC, Iliff NT, Grant MP, et a1. Use of porous polyethylene with embedded titanium in orbital reconstruction:a review of 106 patients[J].Ophthal Plast Reconstr Surg,2007,23(6): 439-444.
[27] Kim YK, Park CS, Kim HK, et al. Correlation between changes of medial rectus muscle section and enophthalmos in patients with medial orbital wall fracture[J]. J Plast Reconstr Surg,2009,62(11): 1379-1383.