| 대한안과학회 학술대회 발표 연제 초록 |
| 성형 F-027 |
| 경계골 소실이 동반된 안와내하벽골절에서 한국인의 안와를 기준으로 삼차원 프린팅 기술로 제작되어진 흡수성 임플란트의 적용. |
부산대학교 의과대학 안과학교실1 부산대학교병원 의생명연구원2 |
| 박정열1, 정우현1, 최희영1,2 |
| 본문 : Purpose Combined orbital floor and medial wall fractures are technically challenging to repair, especially when the inferomedial strut is involved. A pre-, post-operative clinical characteristics and surgical repair technique is described utilizing a single preshaped biodegradable polycarbonate mesh implant customized to Korean population with using three-dimensional printing technique to span both defects. Methods Retrospective reviews was conducted of all cases of combined orbital floor/medial wall fracture involving inferomedial strut repaired with preshaped customized polycarbonate three-dimensionally printed biodegradble mesh performed by the author between February 2017 and February 2019. Exclusion criteria included lack of postoperative imaging or follow-up. Outcome measures included visual acuity, diplopia, Hertel exophthalmometry, and symmetry of orbital volume. Pre and postoperative orbital volume symmetry was determined by analyzing computed tomography scan using Mimics Medical software (20.0 ver, Materialise N.V., Belgium). Results Fracture repair was performed on 7 orbits of 6 patients. All cases except 1 were repaired within 15 days from trauma (1 were repaired after day 121 following trauma). Visual acuity was stable in all cases. Of 5 orbits of 4 patients with preoperative diplopia has improved postoperatively, and there were no cases of new or worsened diplopia following surgery. Of 5 orbits of 4 patients with detachment of the inferior oblique muscle, preoperative diplopia has improved in 1 week, and 2 patients with reattachment, preoperative diplopia has improved in 1 month of follow up. Postoperative asymmetry in Hertel exophthalmometry averaged 0.33mm at 1month of follow up and 0 (range -1 to 1mm) at 6 Month of follow up. Preoperative average orbital volume was 132.6% compared with control (range 109 to 146%, SD 9.6), which improved to 100.6% postoperatively (range 96 to 109%, SD 5.6). The average decrease in orbital volume was 32% (p<0.001) Conclusions Biodegradable polycarbonate mesh implant customized to Korean population with using three-dimensional printing technique can be a good option for combined orbital fracture involving the inferomedial strut. With careful preoperative planning, surgical techinique and proper selection of implant material is essential step to repair technically challenging orbital fracutres. |