本文選題：眶距增寬 + medpor��； 參考：《中國協(xié)和醫(yī)科大學》2010年碩士論文

【摘要】： 眶距增寬癥(orbital hypertelorism)是指兩眼眶間骨性距離過度增寬的一種疾病,是一種嚴重的顱面部畸形。此病只是一種臨床癥狀并非一種獨立的顱面部畸形,它出現(xiàn)在許多類型的顱面部畸形中,如在Tessier顱面裂的分類法中的0,11,12,13和14型顱面裂以及Apert綜合征和Crouzon綜合征等都可以出現(xiàn)眶距增寬的癥狀。眶距增寬癥由Devid Greig于1924年提出并命名。1968年法國整形醫(yī)師Paul Tessier首創(chuàng)了眶距增寬矯正術(shù),即由顱內(nèi)外聯(lián)合徑路的眶距增寬矯正術(shù),但由于手術(shù)創(chuàng)傷大,且截骨限于眶緣,未對眶緣深部的內(nèi)側(cè)壁進行截骨處理,所以術(shù)后容易出現(xiàn)出血、腦脊液漏等并發(fā)癥及術(shù)后復發(fā)的問題。在此后的40年里,隨著顱頜面外科技術(shù)的不斷發(fā)展以及對該病的進一步認識,眶距增寬癥的手術(shù)方式也在不斷的被改進。 目的：通過對眶周軟組織進行充分剝離松解,對眶內(nèi)側(cè)壁進行充分的截骨壓縮,在眶外側(cè)壁填充人工材料medpor的方法,達到減少手術(shù)創(chuàng)傷,降低術(shù)后復發(fā)率的目的。 材料與方法：本研究通過此方法對兩例眶距增寬患者進行手術(shù),均取得滿意效果。兩例患者均為青年男性,年齡分別為18歲和20歲,不合并顱面外科其它畸形。手術(shù)方式均采用“眶內(nèi)側(cè)壁截骨縮窄,眶外側(cè)壁medpor填充,眶距增寬矯正術(shù)”。術(shù)前測量IOD分別為40mm和46mm。內(nèi)眥間距分別為5.5cm和6.Ocm。 結(jié)果：兩例患者術(shù)后均恢復良好,傷口愈合佳,未出現(xiàn)感染,視力減退等并發(fā)癥,術(shù)后眼球動度良好,medpor植入體穩(wěn)定,未出現(xiàn)排異,感染及外露等情況。術(shù)后測量IOD分別為28mm,30mm,外觀改善良好。 結(jié)論：“眶內(nèi)側(cè)壁截骨內(nèi)移,眶外側(cè)壁medpor植入填充,眶距增寬矯正術(shù)”的手術(shù)方式是對傳統(tǒng)的眶內(nèi)側(cè)壁截骨的手術(shù)方式的改良,其不同之處一方面是人工材料medpor的引入；另一方面是對眶內(nèi)側(cè)壁以及眶周軟組織(包括內(nèi)外眥韌帶)的手術(shù)處理。Medpor應(yīng)用于顱頜面外科已經(jīng)有20幾年的歷史,大量的臨床研究表明：和其它植入材料相比,medpor有其獨特的優(yōu)越性�？魞�(nèi)側(cè)壁的截骨除了保留中央骨條外,主要還是在不損傷視神經(jīng)和淚囊的前提下,對篩板進行充分的截骨與壓縮,為眼球內(nèi)移提供充分的空間。08-09年間,我們應(yīng)用此方法對兩例病人進行眶距增寬矯正術(shù),并取得了較為滿意的臨床手術(shù)效果。
[Abstract]:Orbital hypertelorism is a serious craniofacial malformation. It's just a clinical symptom. It's not an independent craniofacial malformation. It appears in many types of craniofacial deformities. For example, in the classification of Tessier craniofacial fissure, the craniofacial fissure of type 0 / 11, type 1213 and 14, as well as Apert syndrome and Crouzon syndrome, can show the symptoms of widening of orbital distance. Orbital distance widening was proposed and named by Devid Greig in 1924. In 1968, Paul Tessier, a French orthopedic surgeon, initiated the orbital distance widening orthopedics. No osteotomy was performed on the deep medial wall of the orbital margin, so complications such as hemorrhage, cerebrospinal fluid leakage and recurrence were easy to occur after operation. Over the next 40 years, with the development of craniomaxillofacial surgery technology and further understanding of the disease, orbital distance-widening surgery has been continuously improved. Objective: to reduce the surgical trauma and the recurrence rate of periorbital soft tissue, decompression of the medial orbital wall and filling of artificial material medpor in the lateral wall of the orbit. Materials and methods: two patients with orbital distance widening were operated by this method with satisfactory results. The two patients were young males, aged 18 and 20 years, respectively, and were not associated with other craniofacial deformities. All operations were performed with osteotomy and constriction of medial orbital wall, medpor filling of lateral orbital wall, and correction of orbital distance widening. The preoperative IODs were 40mm and 46mm. The distance between inner canthus was 5.5cm and 6.Ocm. Results: the two patients recovered well, the wound healed well, no infection, visual acuity and other complications occurred, the eyeball movement was stable, no rejection, infection and exposure were found. Postoperative IOD was 28 mm to 30 mm, and the appearance was improved well. Conclusion: "medial orbital lateral wall osteotomy, orbital lateral wall medpor implantation and correction" is the improvement of traditional orbital medial wall osteotomy. On the one hand, the introduction of artificial material medpor is the difference. On the other hand, the surgical treatment of medial orbital wall and periorbital soft tissue (including medial and medial canthus ligament) has been used in craniomaxillofacial surgery for more than 20 years. A large number of clinical studies have shown that medpor has unique advantages over other implant materials. In addition to preserving the central bone strips, the medial orbital wall osteotomy is mainly performed on the ethmoid plate without damaging the optic nerve and lacrimal sac, so as to provide sufficient space for the intraocular movement. We applied this method to two cases of orbital distance widening orthopedic surgery, and achieved satisfactory clinical results.
【學位授予單位】：中國協(xié)和醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2010
【分類號】：R779.6

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