PDF(Pubmed)
Abstract：
OBJECTIVE: This pilot study aims to evaluate the feasibility and effectiveness of computer-assisted surgery protocol with 3D-preformed orbital titanium mesh (3D-POTM), using presurgical virtual planning and intraoperative navigation in primary inferomedial orbital fracture reconstruction.
METHODS: Between March 2021 and March 2023, perioperative data of patients undergoing surgery for unilateral inferomedial orbital fracture treated with 3D-POTM were analyzed. Presurgical virtual planning with a Standard Triangle Language file of preformed mesh was conducted using the mirrored unaffected contralateral side as a reference, and intraoperative navigation was used. The reconstruction accuracy was determined by: correspondence between postoperative reconstruction mesh position with presurgical virtual planning and difference among the reconstructed and the unaffected orbital volume. Pre- and postoperative diplopia and enophthalmos were assessed.
RESULTS: Twenty-six patients were included. Isolated orbital floor fracture was reported in 14 (53.8%) patients, meanwhile medial wall and floor one in 12 (46.1%) cases. The mean difference between final plate position and ideal digital plan was 0.692 mm (95% CI: 0.601-0.783). The mean volume difference between reconstructed and unaffected orbit was 1.02 mL (95% CI: 0.451-1.589). Preoperative diplopia was settled out in all cases and enophthalmos in 19 (76.2%) of 21 patients.
CONCLUSIONS: The proposed protocol is an adaptable and reliable workflow for the early treatment of inferomedial orbital fractures. It enables precise preoperative planning and intraoperative procedures, mitigating pitfalls and complications, and delivering excellent reconstruction, all while maintaining reasonable costs and commitment times.
METHODS: Between March 2021 and March 2023, perioperative data of patients undergoing surgery for unilateral inferomedial orbital fracture treated with 3D-POTM were analyzed. Presurgical virtual planning with a Standard Triangle Language file of preformed mesh was conducted using the mirrored unaffected contralateral side as a reference, and intraoperative navigation was used. The reconstruction accuracy was determined by: correspondence between postoperative reconstruction mesh position with presurgical virtual planning and difference among the reconstructed and the unaffected orbital volume. Pre- and postoperative diplopia and enophthalmos were assessed.
RESULTS: Twenty-six patients were included. Isolated orbital floor fracture was reported in 14 (53.8%) patients, meanwhile medial wall and floor one in 12 (46.1%) cases. The mean difference between final plate position and ideal digital plan was 0.692 mm (95% CI: 0.601-0.783). The mean volume difference between reconstructed and unaffected orbit was 1.02 mL (95% CI: 0.451-1.589). Preoperative diplopia was settled out in all cases and enophthalmos in 19 (76.2%) of 21 patients.
CONCLUSIONS: The proposed protocol is an adaptable and reliable workflow for the early treatment of inferomedial orbital fractures. It enables precise preoperative planning and intraoperative procedures, mitigating pitfalls and complications, and delivering excellent reconstruction, all while maintaining reasonable costs and commitment times.
摘要：
目的：这项初步研究旨在评估使用3D预制眼眶钛网（3D-POTM）进行计算机辅助手术方案的可行性和有效性，术前虚拟规划和术中导航在原发性眶内骨折重建中的应用。
方法：在2021年3月至2023年3月期间，对接受3D-POTM治疗的单侧眼眶内骨折手术患者的围手术期数据进行分析。使用未受影响的对侧镜像作为参考，使用预制网格的标准三角形语言文件进行术前虚拟规划。术中使用导航。重建精度取决于：术后重建网格位置与术前虚拟计划之间的对应关系以及重建和未受影响的眼眶体积之间的差异。评估术前和术后复视和眼球内陷。
结果：纳入26例患者。14例（53.8%）患者报告了孤立性眶底骨折，同时，内侧壁和地板占12例（46.1％）。最终平板位置与理想数字计划之间的平均差异为0.692mm（95％CI：0.601-0.783）。重建和未受影响的轨道之间的平均体积差为1.02mL（95％CI：0.451-1.589）。所有病例的术前复视均得到解决，21例患者中有19例（76.2％）眼球内陷。
结论：所提出的方案是早期治疗眶内骨折的适应性和可靠的工作流程。它可以实现精确的术前计划和术中程序，减轻陷阱和并发症，并提供出色的重建，同时保持合理的成本和承诺时间。
方法：在2021年3月至2023年3月期间，对接受3D-POTM治疗的单侧眼眶内骨折手术患者的围手术期数据进行分析。使用未受影响的对侧镜像作为参考，使用预制网格的标准三角形语言文件进行术前虚拟规划。术中使用导航。重建精度取决于：术后重建网格位置与术前虚拟计划之间的对应关系以及重建和未受影响的眼眶体积之间的差异。评估术前和术后复视和眼球内陷。
结果：纳入26例患者。14例（53.8%）患者报告了孤立性眶底骨折，同时，内侧壁和地板占12例（46.1％）。最终平板位置与理想数字计划之间的平均差异为0.692mm（95％CI：0.601-0.783）。重建和未受影响的轨道之间的平均体积差为1.02mL（95％CI：0.451-1.589）。所有病例的术前复视均得到解决，21例患者中有19例（76.2％）眼球内陷。
结论：所提出的方案是早期治疗眶内骨折的适应性和可靠的工作流程。它可以实现精确的术前计划和术中程序，减轻陷阱和并发症，并提供出色的重建，同时保持合理的成本和承诺时间。
