Reconstruction of Large Orbital Fractures with High-Density Porous Polyethylene Channel Implants

包含眼窩骨底板與內側壁(orbital floor and medial wall)的大範圍的眼窩骨折不易以如矽橡膠(Silastic plates)等較軟材質的植入物加以矯正。因此我們需要一個較硬但又具有延展性的植入物。高密度多孔性聚乙烯管道性植入物(high-density porous polyethylene channel implants; HDPE channel implants)具有平行管道的構造，可植入小接骨板(miniplates)藉以固定。HDPE具有羥磷灰石(hydroxyapatite)的特性，可容血管與組識長入。我們使用HDPE channel implants來重建四位有眼窩骨底板與內側壁骨折的病人。這四位均是男性，年齡分別是28、41、44與74歲。手術是藉由結膜切開術與外眥切開術(conjunctival incision & lateral cantholysis)。把疝脫出的組織拉回復位之後，依照眼眶骨缺損的形狀把HDPE channel implant加以塑造成形。當植入物放至適當位置，再把置入channel中的miniplate固定到下眼眶綠(inferior orbital rim)。平均追踪的時間為6.25個月。沒有感染、植入物移位、植入物凸出或視力喪失等併發症。三個病人在術前有眼球凹陷(enophthalmos)的情形，在術後均得到了改善。四位病人其眼球轉動的限制(eyeball duction limitation)在術後也都得到改善。術後在視野中心30度的範圍內(central 300 visual field)都沒有複影的情形。雖然我們需要更長的追踪期與更多的病例數來藉以評估HDPE channel implant在重建眼窩骨折應用上的效度，本文確也顯示出其潛力。

關鍵字

無資料

並列摘要

Large orbital fractures involving floors and medial walls are difficult to correct with soft implants, such as thin Silastic plates. Instead, a rigid but malleable implant has to be used. The high-density porous polyethylene (HDPE) is constructed with parallel channels that accept miniplates or microplates for fixation. The HDPE has the characteristics of hydroxyapatite, allowing rapid vascularization and tissue in growth. We used the implant to reconstruct 4 cases of large orbital fractures, involving floor and medial fractures. All 4 patients were male, aged 28, 41, 44, and 74 years old, respectively. All 4 cases were approached by a conjunctival incision with lateral cantholysis. After herniated tissue being pulled back from the sinuses, the HDPE channel implants were shaped and contoured to fit the bony defect of floor and medial wall. After the implant being properly positioned, the miniplate inserted in the channel was fixed to the inferior orbital rim. In an average follow-up of 6.25 months, no complication such as visual loss, infection, migration, or extrusion occurred. Three patients had preoperative enophthalmos, and postoperatively, enophthalmos resolved in 2 cases and improved in another one. Eyeball duction limitation improved in all four cases. No binocular diplopia existed in central 30-degrees of visual field. Although a longer follow-up and larger number of cases are required to evaluate the efficacy of the HDPE channel implant to reconstruct large orbital fractures, this series has shown its potential.

並列關鍵字

blowout fracture ； orbital floor and medial fractures ； porous polyethylene ； orbital reconstruction

國際替代計量

Reconstruction of Large Orbital Fractures with High-Density Porous Polyethylene Channel Implants

全文下載

主題瀏覽