三维人工植入物联合颞部切口入路在眶底缺损合并颧骨骨折修复术中的应用效果观察

Clinical outcomes of three-dimensional artificial implant combined with temporal incision approach in repair of orbital floor defect and zygomatic fracture

  • 摘要:
    背景 眶底和颧骨在面部外伤中极容易受损而导致骨折,传统手术治疗常采用多个联合切口充分暴露术区,创伤大且手术时间长,术后并发症多。
    目的 探讨三维人工植入物联合颞部切口入路修复眶底缺损合并颧骨骨折的效果。
    方法 回顾性分析陆军特色医学中心颌面头颈外科2019年1月 - 2023年1月收治的44例眶底合并颧骨骨折男性患者,所有患者均接受颞部切口入路修复固定法。所有病例分为两组,实验组以羟基磷灰石混合聚醚醚酮制备人工骨作为骨折断端修复材料,对照组以钛网钛板传统金属材料作为骨折断端修复材料,观察两组患者手术前后面部饱满程度、张口度情况和术后并发症等。
    结果 实验组16例,对照组28例,两组年龄差异无统计学意义。所有患者经颞部切口入路骨折切开复位手术治疗后均得到临床治愈。实验组患者术后面部饱满程度较对照组显著提升(0.78 ± 0.07 vs 1.14 ± 0.05,P<0.001),差异有统计学意义。实验组患者张口度较对照组显著改善(2.82 ± 0.04 vs 2.07 ± 0.09,P<0.001),两组患者术后并发症发生率(如感染12.5% vs 10.71%,P=0.091;面神经损伤18.8% vs 28.6%,P=0.717)差异无统计学意义。
    结论 3D打印人工骨能较好地改善眶底缺损合并颧骨骨折术后患者双侧面部对称性和咬合功能。

     

    Abstract:
    Background The orbital floor and zygomatic bones are extremely vulnerable damaged and fracture in facial trauma. Combined multiple surgical incisions are applied in traditional treatment to fully expose the operating area and implant titanium nails and plates, which cause more serious damage, longer operation time and more complications.
    Objective To explore the therapeutic effect of three-dimensional artificial implant combined with temporal incision in repairing orbital floor defect and zygomatic fracture.
    Methods A retrospective analysis was performed on 44 male patients with zygomatic fracture in the maxillofacial head and neck surgery of the Army Medical Center from January 2019 to January 2023. All patients received temporal incision approach for repairing and fixation, and they were randomly divided into experimental group (n=16) and control group (n=28). Hydroxyapatite mixed with polyether ether ketone was applied in experimental group and titanium mesh titanium plate traditional metal in control group to make artificial bone as fracture end repair material. The patients' face fullness, mouth opening area and complications before and after operation were detected in each group.
    Results All patients were clinical cured after receiving temporal incision. Compared with control group, the facial fullness (0.78 ± 0.07 vs 1.14 ± 0.05, P<0.001) and mouth opening area (2.82 ± 0.04 vs 2.07 ± 0.09, P<0.001) of patients in the experimental group were significantly improved. There was no significant difference in the incidence of postoperative complications between the two groups (such as infection: 12.5% vs 10.71%, P=0.091; facial nerve injury: 18.8% vs 28.6%, P=0.717).
    Conclusion 3D printed artificial bone can improve bilateral facial symmetry and occlusal function of patients with orbital floor defect and zygomatic fracture.

     

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