兔眶距增宽手术模型的建立及眶周软组织扩张对眶内移影响的研究
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摘要
目的
一、建立兔眶距增宽颅内外联合径路矫正手术的动物模型，进行眶周截骨，眶内移，通过测量术前术后内眶距(IOD)，即两侧泪嵴点间的距离(泪嵴点即上颌骨鼻突、额骨及泪骨的交汇点)，和X线检查观察眶周骨骼的愈合生长情况，研究了解眶周骨骼截骨移动后变化的规律。
二、探讨眶周软组织扩张技术对兔眶内移后稳定性的影响。通过IOD大体测量、X线摄片及组织学观察，研究术前眶周软组织扩张对眶周截骨，眶内移后IOD变化的影响，进一步探讨眶周软组织扩张技术对增加眶距增宽症矫正术后稳定性的影响。
方法和结果
一、4—6月龄新西兰兔16只，行颅内外联合径路眶周截骨眶内移。额部冠状切口加面部正中矢状切口切开皮肤全层，骨膜下剥离至眶缘，开放眶上孔，游离眶内膜，显露眶内壁。额骨半圆形开窗，保护硬脑膜，保留眶上缘5-10mm骨条及额鼻部“T”形骨条，两眶内侧分别去除约5mm宽骨条，用摆动锯眶周截骨后眶内移，钢丝内固定。眶内侧去除的骨条修整后植入眶外侧间隙，
第四军医大学硕士学位论文
缝合内外毗韧带，放回额骨瓣并钢丝固定，适当切除眶间多余皮
肤后缝合切口。通过术前术后IOD大体测量和X线检查，观察眶周
骨骼的愈合生长情况，研究了解眶周骨骼截骨移动后愈合的规律。
术中用游标卡尺测量眶移动前后的IOD;术后12周，处死实
验动物，再次进行内眶距的测量。并在术前、术后即刻及术后12
周分别进行X线摄片。
经手术前后IOD大体测量和X线检查观察，16只兔术前平均
IOD 2.16em，术后即刻平均 IOD 0.74em，术后12周平均IOD
0.96cm，有明显复发(P<0 .01)，x线检查见骨愈合处有较多新骨生
成。
二、4一6月龄新西兰兔16只，随机分为两组，每组8只。
一组为实验组，作眶周软组织扩张后行颅内外联合径路眶周截骨
眶内移;另一组为对照组，不作眶周软组织扩张，眶周截骨眶内
移。通过IOD大体测量、X线摄片及组织学观察，研究术前眶周
软组织扩张对眶距增宽症矫正术后IOD稳定性的影响，进一步探
讨眶周软组织扩张技术对眶距增宽症矫正术后效果的作用。
试验组行眶内移前6周，先行眶周软组织扩张。沿眶外侧骨
膜下剥离至眶缘，充分游离软组织下间隙，植入30ml软组织扩张
器囊，将导管和注水阀反方向埋于额部皮下，缝合皮肤切口。术
后注水10ml，每隔1周注水10ml至结束。根据动物具体情况，
注水至25一30ml后2周，取出软组织扩张器。眶内移手术步骤同
月lJ。
全部16只兔在眶内移术后12周处死，进行IOD大体测量，X
线摄片和组织学检查。16只兔IOD平均缩窄1.20cm，术后12周
实验组平均IOD为0.57cm，对照组平均IOD为0.68cm，两组有显著
性差异(P<0 .01)。组织学检查证实实验组骨愈合处有较坚强骨桥
连接形成，对照组眶间新生骨组织较多。
第四军医大学硕士学位论文
结论
一、在兔眶距增宽矫正手术模型中，术后12周眶距增宽有明
显复发。
二、眶周软组织扩张实验组和对照组，术后即刻IOD的缩短
没有明显差异，但术后12周IOD的数值出现了明显差异，说明实
验组经过眶周软组织扩张，眶内移后骨愈合较稳定，对照组出现
了眶距增宽畸形复发。
使用眶周软组织扩张技术可有效地防止眶内移后眶距增宽的
复发，证明眶周软组织不足是眶距增宽矫正术后复发的原因之一。
Objective
1 To establish the correction models of orbital hypertelorism in rabbit. Give para-orbital osteotomies and medial translocation. Interorbital distanse (IOD) and Healing of the bone between orbital were studied with gross measurement and X-ray examination before and after operation and 12 weeks later.
2 Investigate the effect of para-orbital soft-tissue expansion before orbital osteotomies and medial translocation by combined intracranial-extracranial approach. IOD and healing of the bone between orbital were studied with gross measurement, X-ray, and histological examination before and after operation and 12 weeks later. Methods and Results
1 16 New Zealand rabbits were given para-orbital osteotomies and medial translocation by combined intracranial-extracranial approach. The coronary, palpebral.and nasofrontal incisions are necessary to expose the craniofacial skeleton. Leaving the periosteum intact in the frontal area as far as 5-10 mm from the orbital rim and continuing underthe periosteum in the orbital and malar regions. The bone blocks to be resected can be performed by an ethmoidofrontal resection with a frontal crown to provide a base for bone graft
fixation. A resection of the ethmoid cells leaving a central T shape in the nasofrontal area to rebuild the dorsum of the nose, and 5mm bone graft were resected beside the T shape. Osteotomies separate the whole orbit from the skull and facial bones in order to mobilize the orbit medially. Finally, fix these bone graft with steel wire. IOD and Healing of the bone between orbital were studied with gross measurement and X-ray examination before and after operation and 12 weeks later.
IOD were measured by vernier caliper before and after operation, IOD is the distance between lacrimonasal. Excute the rabbits 12 weeks after operation, and measure IOD again. Give X-ray examination before and after operation and 12 weeks later.
The average IOD of the rabbits is 17.2mm before operation and 8.4mm after operation. 12 weeks after operation, the average IOD of the rabbits recurred to 9.6mm. the relapse is significant. (P<0.01). 2 16 New Zealand rabbits were divided into two groups randomly. In experimental group, para-orbital soft-tissue expansion were given before orbital osteotomies and medial translocation; in the contrast experimental group without soft-tissue expansion. 12 weeks after the correction operation, IOD and healing of the bone between orbital were studied with gross measurement, X-ray, and histological examination before and after operation and 12 weeks later.
In experimental group, para-orbital soft-tissue expansion were given before orbital osteotomies and medial translocation. 30ml tissue expanders with remote reservoir domes were used in all instances. Put the expanders under periosteum around the orbit. Inflation begins after operation, the amount of fluid injected is individualized about 30 ml. Orbital osteotomies and medial translocation 2 weeks after the last inflation.
The interorbital distance were decreased 14.6 nm on average. At the 12th week after correction operation, the IOD of the para-orbital soft-tissue expansion group were 15.3mm and were 18.5 mm in the other group on average. There is significant difference in statistics (P<0.01). More new bone were observed in the non-soft-tissue-expansion group. Conclusion
1 There is significant relapse of the IOD after the orbital osteotomies and medial translocation by combined intracranial-extracranial approach in rabbit models.
2 The para-orbital soft-tissue expansion technique may be an effective technique for the stability of the corrected IOD in orbital hypertelorism.
Lack of soft tissue around orbit can result in relapse after hypertelorism correction. The para-orbital soft-tissue expansion technique may help prevent the relapse of orbital hypertelorism after correction.
一、建立兔眶距增宽颅内外联合径路矫正手术的动物模型，进行眶周截骨，眶内移，通过测量术前术后内眶距(IOD)，即两侧泪嵴点间的距离(泪嵴点即上颌骨鼻突、额骨及泪骨的交汇点)，和X线检查观察眶周骨骼的愈合生长情况，研究了解眶周骨骼截骨移动后变化的规律。
二、探讨眶周软组织扩张技术对兔眶内移后稳定性的影响。通过IOD大体测量、X线摄片及组织学观察，研究术前眶周软组织扩张对眶周截骨，眶内移后IOD变化的影响，进一步探讨眶周软组织扩张技术对增加眶距增宽症矫正术后稳定性的影响。
方法和结果
一、4—6月龄新西兰兔16只，行颅内外联合径路眶周截骨眶内移。额部冠状切口加面部正中矢状切口切开皮肤全层，骨膜下剥离至眶缘，开放眶上孔，游离眶内膜，显露眶内壁。额骨半圆形开窗，保护硬脑膜，保留眶上缘5-10mm骨条及额鼻部“T”形骨条，两眶内侧分别去除约5mm宽骨条，用摆动锯眶周截骨后眶内移，钢丝内固定。眶内侧去除的骨条修整后植入眶外侧间隙，
第四军医大学硕士学位论文
缝合内外毗韧带，放回额骨瓣并钢丝固定，适当切除眶间多余皮
肤后缝合切口。通过术前术后IOD大体测量和X线检查，观察眶周
骨骼的愈合生长情况，研究了解眶周骨骼截骨移动后愈合的规律。
术中用游标卡尺测量眶移动前后的IOD;术后12周，处死实
验动物，再次进行内眶距的测量。并在术前、术后即刻及术后12
周分别进行X线摄片。
经手术前后IOD大体测量和X线检查观察，16只兔术前平均
IOD 2.16em，术后即刻平均 IOD 0.74em，术后12周平均IOD
0.96cm，有明显复发(P<0 .01)，x线检查见骨愈合处有较多新骨生
成。
二、4一6月龄新西兰兔16只，随机分为两组，每组8只。
一组为实验组，作眶周软组织扩张后行颅内外联合径路眶周截骨
眶内移;另一组为对照组，不作眶周软组织扩张，眶周截骨眶内
移。通过IOD大体测量、X线摄片及组织学观察，研究术前眶周
软组织扩张对眶距增宽症矫正术后IOD稳定性的影响，进一步探
讨眶周软组织扩张技术对眶距增宽症矫正术后效果的作用。
试验组行眶内移前6周，先行眶周软组织扩张。沿眶外侧骨
膜下剥离至眶缘，充分游离软组织下间隙，植入30ml软组织扩张
器囊，将导管和注水阀反方向埋于额部皮下，缝合皮肤切口。术
后注水10ml，每隔1周注水10ml至结束。根据动物具体情况，
注水至25一30ml后2周，取出软组织扩张器。眶内移手术步骤同
月lJ。
全部16只兔在眶内移术后12周处死，进行IOD大体测量，X
线摄片和组织学检查。16只兔IOD平均缩窄1.20cm，术后12周
实验组平均IOD为0.57cm，对照组平均IOD为0.68cm，两组有显著
性差异(P<0 .01)。组织学检查证实实验组骨愈合处有较坚强骨桥
连接形成，对照组眶间新生骨组织较多。
第四军医大学硕士学位论文
结论
一、在兔眶距增宽矫正手术模型中，术后12周眶距增宽有明
显复发。
二、眶周软组织扩张实验组和对照组，术后即刻IOD的缩短
没有明显差异，但术后12周IOD的数值出现了明显差异，说明实
验组经过眶周软组织扩张，眶内移后骨愈合较稳定，对照组出现
了眶距增宽畸形复发。
使用眶周软组织扩张技术可有效地防止眶内移后眶距增宽的
复发，证明眶周软组织不足是眶距增宽矫正术后复发的原因之一。
Objective
1 To establish the correction models of orbital hypertelorism in rabbit. Give para-orbital osteotomies and medial translocation. Interorbital distanse (IOD) and Healing of the bone between orbital were studied with gross measurement and X-ray examination before and after operation and 12 weeks later.
2 Investigate the effect of para-orbital soft-tissue expansion before orbital osteotomies and medial translocation by combined intracranial-extracranial approach. IOD and healing of the bone between orbital were studied with gross measurement, X-ray, and histological examination before and after operation and 12 weeks later. Methods and Results
1 16 New Zealand rabbits were given para-orbital osteotomies and medial translocation by combined intracranial-extracranial approach. The coronary, palpebral.and nasofrontal incisions are necessary to expose the craniofacial skeleton. Leaving the periosteum intact in the frontal area as far as 5-10 mm from the orbital rim and continuing underthe periosteum in the orbital and malar regions. The bone blocks to be resected can be performed by an ethmoidofrontal resection with a frontal crown to provide a base for bone graft
fixation. A resection of the ethmoid cells leaving a central T shape in the nasofrontal area to rebuild the dorsum of the nose, and 5mm bone graft were resected beside the T shape. Osteotomies separate the whole orbit from the skull and facial bones in order to mobilize the orbit medially. Finally, fix these bone graft with steel wire. IOD and Healing of the bone between orbital were studied with gross measurement and X-ray examination before and after operation and 12 weeks later.
IOD were measured by vernier caliper before and after operation, IOD is the distance between lacrimonasal. Excute the rabbits 12 weeks after operation, and measure IOD again. Give X-ray examination before and after operation and 12 weeks later.
The average IOD of the rabbits is 17.2mm before operation and 8.4mm after operation. 12 weeks after operation, the average IOD of the rabbits recurred to 9.6mm. the relapse is significant. (P<0.01). 2 16 New Zealand rabbits were divided into two groups randomly. In experimental group, para-orbital soft-tissue expansion were given before orbital osteotomies and medial translocation; in the contrast experimental group without soft-tissue expansion. 12 weeks after the correction operation, IOD and healing of the bone between orbital were studied with gross measurement, X-ray, and histological examination before and after operation and 12 weeks later.
In experimental group, para-orbital soft-tissue expansion were given before orbital osteotomies and medial translocation. 30ml tissue expanders with remote reservoir domes were used in all instances. Put the expanders under periosteum around the orbit. Inflation begins after operation, the amount of fluid injected is individualized about 30 ml. Orbital osteotomies and medial translocation 2 weeks after the last inflation.
The interorbital distance were decreased 14.6 nm on average. At the 12th week after correction operation, the IOD of the para-orbital soft-tissue expansion group were 15.3mm and were 18.5 mm in the other group on average. There is significant difference in statistics (P<0.01). More new bone were observed in the non-soft-tissue-expansion group. Conclusion
1 There is significant relapse of the IOD after the orbital osteotomies and medial translocation by combined intracranial-extracranial approach in rabbit models.
2 The para-orbital soft-tissue expansion technique may be an effective technique for the stability of the corrected IOD in orbital hypertelorism.
Lack of soft tissue around orbit can result in relapse after hypertelorism correction. The para-orbital soft-tissue expansion technique may help prevent the relapse of orbital hypertelorism after correction.
引文
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