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Abstract：
Reconstruction of post traumatic orbital defects has undergone a stepwise evolution following developments in reconstructive materials and surgical techniques. Advances in communication between surgical teams and design technicians have allowed provision of bespoke surgical plates with a high degree of accuracy and surgical relevance in an appropriate timeframe. We present a case series of 41 consecutive patients treated in London and BernBern Switzer between March 2019 and September 2020 with extensive defects reconstructed with patient specific orbital plates. Complexity of fracture was risk adjusted using the Jaquiery scale with one patient (J3), 14 patients (J4), and 26 Patients (J5). Outcome was assessed by accuracy of fit at the surgical margins and was 94.5%. The study group was statistically tested against a previous series by the same group and was statistically different with respect to the case complexity (p<0.001) and accuracy of fit (p<0.001) (Fisher\'s exact test). Complications included the removal on one plate due to patient choice, with perfect surgical position and resolving diplopia. Only one plate articulation was poor, this mitigated by the size of the defect and the orbital soft tissue swelling which prohibited seating the implant. The patient remains well with acceptable function and satisfactory aesthetics. We present design considerations including the use two part plates, and surgical pearls to achieve predictable placement. We believe that the use of custom plates for reconstruction of Jaquiery 4 and 5 should be considered. We regard this technology as a game changer in surgical management of the complex high risk orbit.
摘要：
随着重建材料和外科技术的发展，创伤后眼眶缺损的重建经历了逐步发展。手术团队和设计技术人员之间的沟通进展允许在适当的时间范围内提供具有高度准确性和手术相关性的定制手术板。我们提供了一系列病例，包括2019年3月至2020年9月在伦敦和BernBernSwitzer治疗的41例连续患者，这些患者用患者特定的眼眶板重建了广泛的缺损。使用Jaquery量表对一名患者（J3）的骨折复杂性进行风险调整，14名患者（J4），和26名患者（J5）。结果是通过手术边缘的拟合精度评估的，为94.5％。研究组与同一组先前的系列进行了统计学检验，并且在病例复杂性（p<0.001）和拟合准确性（p<0.001）方面具有统计学差异（Fisher精确检验）。并发症包括由于患者的选择而在一个板上移除，完美的手术位置和解决复视。只有一个板关节连接不良，缺损的大小和眼眶软组织肿胀使植入物无法入座，从而减轻了这种情况。患者保持良好的可接受的功能和令人满意的美学。我们提出了设计考虑因素，包括使用两部分板，和手术珍珠以实现可预测的放置。我们认为，应考虑使用定制板重建Jaquery4和5。我们认为这项技术是复杂的高风险轨道手术管理中的游戏规则改变者。
