Using Titanium Mesh or Micromesh Plates to Reconstruct Complicated Orbital Blowout Fractures

以鈦金屬網板或微細網板重建複雜性眼窩爆破性骨折

張丞賢(Cheng-Hsien Chang) ； 王惠珠(Hwei-Zu Wang) ； 賴聖宗(Steven Lai)

《中華民國眼科醫學會雜誌》 35卷3期 (1996/09) Pp. 255-263

https://doi.org/10.30048/ACTASOS.199609.0001

摘要

複雜性眼窩爆破性骨折可包含大片眼窩底板骨折，也可包含貳或三面眼窩壁之骨折。這類骨折較難以傳統的軟矽板重建。而必需以較硬且有延展性之內置板重建。如此才能承載整個眼窩之重量，塑型去含蓋所有的骨折缺口，且容易固定。七個複雜猛爆性眼窩骨折以鈦金屬網板或微細網板重建。其中有五男二女，平均30.5歲。六個病例含大片眼窩底板及內壁骨折。其中三病例更有眼窩外壁及顴顎骨骨折。另外一病例為眼窩內壁後方及小部份眼窩底板骨折。所有病例皆有大於二釐米之眼窩內陷。六個病例有顯著之眼球轉動障礙。以眼窩內壁破損為主之病例則僅有往右側方看時才產生複視。六個病例在受傷後超過一個月才以金屬網板做眼窩重建手術。金屬網板容易鑄型去覆蓋所有骨折缺損。且由於容易固定能承載整個眼窩的重量。追踪16.1個月之後，除了眼球剜除病例外四個病例眼球內陷皆小於2釐米。其他三個眼球剜除病人裝上假眼之後也尚滿意面容。一位病人術後所有視野皆無複視。其他三個有視力病例則在中心視野沒有複視。沒有任何內置物副作用如移位，感染等發生。雖然這僅是七個病例的臨床報告，但對於此類複雜性眼窩骨折，鈦金屬網板或微細網板仍被證明為重建內置物一個根好的選擇。

並列摘要

Complicated orbital blowout fractures, which have either large floor fractures or multi-wall fractures, are difficult to reconstruct with traditional soft implants such as silastic implants. In such situations, rigid but malleable implants are required, so that they can uphold the whole weight of the orbital tissue, reduce the enlarged orbital volume, be shaped to cover the multi-wall defects, and be easier to fixate. Titanium mesh and micromesh plates were used to reconstruct 7 cases of complicated blowout fractures. There were 5 males and 2 females, average age 30.5years old. Six cases had large orbital floor fractures in combination with medial wall fractures. Three cases also had lateral walls and zygomaticomaxillary complex (ZMC) fractures. Only one case had fractures in the posterior part of the medial wall and a small part of the floor. All cases had enophthalmos of more than 2mm. Six cases had severe limitations in eyeball duction. One case with mostly medial wall fractures had diplopia only at the extreme right lateral gaze. Six cases were operated on from 6 weeks to 8 months after their injuries were incurred. In the operation, the fracture defects were reconstructed with titanium plates after complete release of the herniated tissues. The titanium plates could be easily shaped and contoured to cover all the large defect areas. Rigid plates can also be securely fixed so that the entire orbital contents can be upheld. After a mean follow-up of 16.1 months, the enophthalmos of the 4 patients without eviscerations were corrected back to less than 2mm. Three cases with eviscerations and intraocular implants were satisfied with their facial appearance with the prosthesis. There was no sign of diplopia in one patient at all fields of gaze. Three patients had no diplopia at the central field of gaze. There were no complications of the implant extusion, migration or infection. Although this was only a small series of 7 cases, the titanium mesh or micromesh plates were proved to be a good alternative for such complicated orbital fractures.

並列關鍵字

Complicated orbital blowout fracture ； Titanium mesh or micromesh plates