张秀丽 季中锟 柳晓静

[摘要]目的：探讨3D打印钛网预成形联合术后严密护理对眼眶爆裂骨折患者预后情况的影响。方法：选取笔者医院收治的眼眶爆裂性骨折患者122例，随机分为对照组和观察组，分别62例和60例。对照组患者予以常规钛网置入术，观察组患者予以3D打印钛网预成形，术后均予以视力监测、眼肌运动训练等严密护理。观察并比较两组患者钛网贴合度，复视、眼球运动及眼球突出等症状的改善情况。结果：观察组患者CT矢状位上修复眼眶底的钛网呈S形，对照组患者呈弯向眼眶内的弧形。术后3个月、6个月，观察组患者复视、眼球运动受限情况治愈率均高于对照组，差异具有统计学意义（P<0.05）;术后，两组患者患眼眼球突出度差值均降低，观察组显著低于对照组，差异具有统计学意义（P<0.05）。结论：3D打印钛网预成形与眼眶爆裂性骨折患者眶底契合度更高，联合术后严密护理对复视、眼球运动受限及眼球突出等症状的改善作用更好，患者预后更好。

[关键词]眼眶爆裂性骨折;3D打印钛网预成形;常规钛网置入术;复视;眼球运动;眼球突出度

[中图分类号]R622    [文献标志码]A    [文章编号]1008-6455（2020）04-0034-03

Abstract： Objective To explore the effect on prognosis of patients with orbital burst fracture by using 3D printing titanium mesh preform combined with postoperative intensive care. Methods 122 patients with orbital burst fracture admitted to our hospital were randomly divided into the control group （n=62） and the observation group （n=60）. Patients in the control group were treated with conventional titanium mesh implantation， patients in the observation group were treated with 3D printing titanium mesh preform.After operation， all patients were given strict nursing such as vision monitoring and eye muscle exercise training. The improvement of titanium mesh adhesion， diplopia， eye movement and exophthalmos were observed and comparedbetween the two groups. Results In the observation group， the titanium mesh for repairing orbital floor on CT sagittal plane was S-shaped， while in the control group， the titanium mesh was curved into orbit. At 3 months and 6 months after operation， the cure rates of diplopia and limitation of eye movement in the observation group were higher than those in the control group， the differences were statistically significant （P<0.05）. After the operation， the difference of exophthalmos in the two groups decreased， the observation group was significantly lower than that in the control group （P<0.05）. Conclusion 3D printing titanium mesh preform has a higher coincidence with orbital floor in patients with orbital blowout fracture. 3D printing titanium mesh preform combined with postoperative intensive care can improve diplopia， eye movement limitation and exophthalmos， and the prognosis of patients is better.

Keywords： orbital burst fracture; 3D printing titanium mesh preform; conventional titanium mesh implantation; diplopia; eye movements; protrusion of eyeball

眼眶爆裂性骨折是一種眶部挫伤所致的眶壁骨折，多由车祸、体育运动或斗殴等直接打击眼睑和眼球导致，且致伤物较眼眶大，患者以复视、眼球运动受限及眼球突出为主要症状[1]。临床以手术治疗为主，以恢复眼眶结构及生理功能，回纳眶内容物，解除水肿和压迫为治疗目的[2]。常规手术中运用的钛网多为平面形态，在术中经过医师的修剪和弯制得以应用，但其常需反复多次塑形和置入，可导致患者术后出现严重水肿，影响眼部功能和生理结构的恢复[3]。而3D打印技术是一种以数字模型文件为基础，运用粉末状或塑料等可粘合材料，逐层打印构造物体的技术，在临床是一种新兴技术，对于眼眶爆裂性骨折患者，其能够在置入前对钛网进行精确预塑形，缩短手术时间[4]。……