采用榫卯关节的创新眼眶边缘重新定位：现代手术和中国传统木工的融合

摘要(中文译文)

眶缘复位是外侧开眶术中的关键步骤。本研究旨在介绍一种受中国传统木工工艺启发的新型榫卯关节固定（MTF）技术，用于外侧眶缘重建。本回顾性病例系列分析了采用MTF进行平衡性眶减压手术的甲状腺眼病（TED）患者的结局。分析了临床结局、手术植入物使用数量及住院费用。此外，选取另一例采用钛板螺钉固定（PSF）治疗患者的同侧眶模型作为对照，进行三维有限元分析。分析在咬肌固定及对咬肌施加咬合力两种条件下进行。共纳入9例接受MTF重建的TED患者（12眶）。眼球突出度平均回退5.3±0.9 mm。未观察到严重出血、视力丧失或眶缘移位等并发症。有限元分析显示，MTF的最大应力低于PSF：8.59 MPa vs. 91.33 MPa（咬肌固定）和16.33 MPa vs. 91.20 MPa（施加力）。MTF的最大位移也较低：0.010 mm vs. 0.014 mm（咬肌固定）和0.026 mm vs. 0.033 mm（施加力）。住院费用中植入物材料费用减少288.43至412.00美元，较PSF降低约84.3%。总之，MTF技术在外侧开眶术眶缘复位中展现出安全性、有效性及生物力学优势。该技术还降低了患者费用，为传统固定方法提供了一种有前景的替代方案。

Abstract

Orbital rim repositioning is a pivotal step in lateral orbitotomy. This study aims to introduce a novel mortise-tenon joint fixation (MTF) technique inspired by traditional Chinese woodcraft for lateral orbital rim reconstruction. This retrospective case series analyzed outcomes in patients with thyroid eye disease (TED) undergoing balanced orbital decompression surgery using MTF. The clinical outcomes, the number of surgical implants used, and hospitalization costs were analyzed. Additionally, an orbital model of the same laterality, derived from another patient treated with titanium plate-and-screw fixation (PSF), was selected as the comparator for the three-dimensional finite element analysis. Analysis was conducted with masseter muscle fixation and the application of occlusal force on the masseter muscle. Nine TED patients (12 orbits) undergoing MTF reconstruction were enrolled. A mean proptosis reduction of 5.3 ± 0.9 mm was achieved. No complications such as severe hemorrhage, vision loss, or orbital rim displacement were observed. Finite element analysis showed that maximum stress was lower with MTF than with PSF: 8.59 MPa vs. 91.33 MPa (masseter muscle fixation) and 16.33 MPa vs. 91.20 MPa (force applied). Maximum displacement was also lower for MTF: 0.010 mm vs. 0.014 mm (masseter muscle fixation) and 0.026 mm vs. 0.033 mm (force applied). Implant material expenses in hospitalization costs decreased by $288.43-$412.00, representing an approximate 84.3% reduction compared to PSF. In summary, the MTF technique demonstrates safety, effectiveness, and biomechanical advantages for orbital rim repositioning during lateral orbitotomy. It also reduces patient costs, offering a promising alternative to traditional fixation methods.

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