眶内侧壁截骨内移结合眶外侧壁medpor填充治疗眶距增宽症的临床研究

发布时间：2018-06-21 19:45

本文选题：眶距增宽 + medpor　；参考：《中国协和医科大学》2010年硕士论文

【摘要】： 眶距增宽症(orbital hypertelorism)是指两眼眶间骨性距离过度增宽的一种疾病,是一种严重的颅面部畸形。此病只是一种临床症状并非一种独立的颅面部畸形,它出现在许多类型的颅面部畸形中,如在Tessier颅面裂的分类法中的0,11,12,13和14型颅面裂以及Apert综合征和Crouzon综合征等都可以出现眶距增宽的症状。眶距增宽症由Devid Greig于1924年提出并命名。1968年法国整形医师Paul Tessier首创了眶距增宽矫正术,即由颅内外联合径路的眶距增宽矫正术,但由于手术创伤大,且截骨限于眶缘,未对眶缘深部的内侧壁进行截骨处理,所以术后容易出现出血、脑脊液漏等并发症及术后复发的问题。在此后的40年里,随着颅颌面外科技术的不断发展以及对该病的进一步认识,眶距增宽症的手术方式也在不断的被改进。目的：通过对眶周软组织进行充分剥离松解,对眶内侧壁进行充分的截骨压缩,在眶外侧壁填充人工材料medpor的方法,达到减少手术创伤,降低术后复发率的目的。材料与方法：本研究通过此方法对两例眶距增宽患者进行手术,均取得满意效果。两例患者均为青年男性,年龄分别为18岁和20岁,不合并颅面外科其它畸形。手术方式均采用“眶内侧壁截骨缩窄,眶外侧壁medpor填充,眶距增宽矫正术”。术前测量IOD分别为40mm和46mm。内眦间距分别为5.5cm和6.Ocm。结果：两例患者术后均恢复良好,伤口愈合佳,未出现感染,视力减退等并发症,术后眼球动度良好,medpor植入体稳定,未出现排异,感染及外露等情况。术后测量IOD分别为28mm,30mm,外观改善良好。结论：“眶内侧壁截骨内移,眶外侧壁medpor植入填充,眶距增宽矫正术”的手术方式是对传统的眶内侧壁截骨的手术方式的改良,其不同之处一方面是人工材料medpor的引入；另一方面是对眶内侧壁以及眶周软组织(包括内外眦韧带)的手术处理。Medpor应用于颅颌面外科已经有20几年的历史,大量的临床研究表明：和其它植入材料相比,medpor有其独特的优越性。眶内侧壁的截骨除了保留中央骨条外,主要还是在不损伤视神经和泪囊的前提下,对筛板进行充分的截骨与压缩,为眼球内移提供充分的空间。08-09年间,我们应用此方法对两例病人进行眶距增宽矫正术,并取得了较为满意的临床手术效果。
[Abstract]:Orbital hypertelorism is a serious craniofacial malformation. It's just a clinical symptom. It's not an independent craniofacial malformation. It appears in many types of craniofacial deformities. For example, in the classification of Tessier craniofacial fissure, the craniofacial fissure of type 0 / 11, type 1213 and 14, as well as Apert syndrome and Crouzon syndrome, can show the symptoms of widening of orbital distance. Orbital distance widening was proposed and named by Devid Greig in 1924. In 1968, Paul Tessier, a French orthopedic surgeon, initiated the orbital distance widening orthopedics. No osteotomy was performed on the deep medial wall of the orbital margin, so complications such as hemorrhage, cerebrospinal fluid leakage and recurrence were easy to occur after operation. Over the next 40 years, with the development of craniomaxillofacial surgery technology and further understanding of the disease, orbital distance-widening surgery has been continuously improved. Objective: to reduce the surgical trauma and the recurrence rate of periorbital soft tissue, decompression of the medial orbital wall and filling of artificial material medpor in the lateral wall of the orbit. Materials and methods: two patients with orbital distance widening were operated by this method with satisfactory results. The two patients were young males, aged 18 and 20 years, respectively, and were not associated with other craniofacial deformities. All operations were performed with osteotomy and constriction of medial orbital wall, medpor filling of lateral orbital wall, and correction of orbital distance widening. The preoperative IODs were 40mm and 46mm. The distance between inner canthus was 5.5cm and 6.Ocm. Results: the two patients recovered well, the wound healed well, no infection, visual acuity and other complications occurred, the eyeball movement was stable, no rejection, infection and exposure were found. Postoperative IOD was 28 mm to 30 mm, and the appearance was improved well. Conclusion: "medial orbital lateral wall osteotomy, orbital lateral wall medpor implantation and correction" is the improvement of traditional orbital medial wall osteotomy. On the one hand, the introduction of artificial material medpor is the difference. On the other hand, the surgical treatment of medial orbital wall and periorbital soft tissue (including medial and medial canthus ligament) has been used in craniomaxillofacial surgery for more than 20 years. A large number of clinical studies have shown that medpor has unique advantages over other implant materials. In addition to preserving the central bone strips, the medial orbital wall osteotomy is mainly performed on the ethmoid plate without damaging the optic nerve and lacrimal sac, so as to provide sufficient space for the intraocular movement. We applied this method to two cases of orbital distance widening orthopedic surgery, and achieved satisfactory clinical results.
【学位授予单位】：中国协和医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R779.6

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