自体阔筋膜移植联合钛板钛钉内固定矫正难治性内眦畸形

目的评价自体阔筋膜移植联合钛板钛钉钢丝内固定矫正难治性内眦畸形的手术效果。设计回顾性病例系列。研究对象8例难治性内眦畸形患者,车祸伤6例,砂轮击伤1例,泪囊肿物摘除术后1例。其中2例为内眦畸形矫正术后再次复发者。方法采用自体大腿阔筋膜,将其一端缝合固定于内眦角深部组织即相当于内眦韧带残端处,另一端在泪前嵴保存完好的患者中,通过钢丝、钛钉固定于泪前嵴上,在泪前嵴和鼻骨破坏明显的患者中,通过钢丝、钛板、钛钉固定于深部稳定性较强的骨质上。主要指标双眼内眦与鼻中线间距,外观是否对称。结果8例患者术后内眦畸形明显矫正,外观显著改善,随诊6～12个月效果持续稳定。结论自体阔筋膜移植联合钛板钛钉钢丝内固定矫正难治性内眦畸形效果良好,可以有效预防复发。     

经羟基磷灰石处理的纯钛表面有利于角膜成纤维细胞的粘附和增殖

目的:研究与纯钛相比,经羟基磷灰石表面改性处理的纯钛是否能增加兔角膜基质成纤维细胞在其表面的粘附和增殖.方法:利用生物活性的羟基磷灰石对纯钛进行表面改性.将第4代兔角膜基质成纤维细胞接种于羟基磷灰石表面改性的钛、纯钛及玻璃表面,24,48,72 h后,使用丫啶橙染色的方法观察材料表面细胞的粘附和增殖情况,电镜观察材料表面的细胞形态.结果:各个时间点,羟基磷灰石表面改性的钛表面的细胞数都多于其他材料(P＜0.05).24 h,羟基磷灰石表面改性的钛表面和玻璃表面的细胞扩展面积要大于纯钛表面.72 h电镜观察发现羟基磷灰石表面改性的钛表面的细胞扩展面积最大,细胞张力丝最长.结论:与纯钛相比,经羟基磷灰石表面改性处理的纯钛可增加兔角膜基质成纤维细胞在其表面粘附和增殖     

微型钛板在眼眶骨折整复中的应用

目的:探讨应用微型钛板整复固定眼眶骨折的临床应用价值。方法:对65例眼眶骨折患者,采取不同方法整复并应用微型钛板固定。认为在软组织裂伤缝合时尽可能早期行眼眶骨折整复固定,两个部位错位骨折,复位后即应用微型钛板坚固内固定。粉碎性骨折Ⅰ期难以完全复位时,尽可能把可以复位的先行整复,余者应在5～10d内行II期整复,并用微钛板根据骨折部位和形态,采用1～3个骨折线固定。若眶缘粉碎性骨折,中间碎骨片不易固定,可将钛板越过碎骨片,呈桥状两端固定。结果:在软组织清创缝合时行I期整复微型钛板固定14例,眶壁重度粉碎性骨折行II期整复微型钛板固定51例。钛板无1例产生排斥反应或脱落等并发症。结论:眼眶骨折经早期和恰当方法整复,微型钛板可以使眼眶骨折坚固内固定,使用方法简便,容易掌握,是目前整复眼眶和颜面部骨折最有效的材料。完全可以修复颜面畸形,并恢复眼球运动功能。     

改良钛支架人工角膜生物相容性的实验研究

目的 探讨改良钛支架人工角膜的生物相容性和角膜生物愈合的过程.方法 实验研究.设计与制备改良钛支架人工角膜,钛支架采用喷砂、羟基磷灰石涂层处理,镜柱用聚甲基丙烯酸甲酯为原料按设计好的图纸手工磨制.将18只正常新西兰白兔采用单纯随机抽样方法分为A、B、C组,每组6只.18只新西兰白兔角膜碱烧伤模型采用单纯随机抽样方法分为E、F、G组,每组6只.其中A、E组和B、F组兔右眼角膜基质层内分别植入改良支架和对照支架(无涂层),C、G组仅做角膜板层切口;另取4只(分别为2只正常动物模型、2只碱烧伤模型)即D、H组分别作为空白对照;术后1、3个月取材,取出支架做拉出实验和扫描电镜检查;角膜组织行苏木素-伊红(HE)染色、透射电镜检查.另取8只兔(其中2只碱烧伤模型)植入改良支架,3个月后植入镜柱.两组剪切力比较采用t检验.结果 改良后的人工角膜支架表面呈鳞片状微孔结构,植入兔角膜反应轻,术后1、3个月取材,组织学检查见A、E组支架与角膜界面处成纤维细胞数多于B、F组支架.3个月时拉出试验测定剪切力A与B组比较、E与F组比较差异均有统计学意义(t=3.297,P<0.05;t=4.237,P<0.05),改良支架植入角膜3个月后的剪切力较对照支架强.扫描电镜检查显示A、E组支架表面被细胞外基质包裹,而B、F组支架细胞附着量明显少.透射电镜检查显示支架周围的胶原纤维束紊乱,A、E组支架与角膜的结合方式垂直或成一定角度,结合更牢固.支架植入后碱烧伤模型组角膜基质较正常兔角膜组愈合延迟.结论 改良钛支架人工角膜促进了材料与组织界面愈合,无论正常还是碱烧伤动物体内,改良钛支架人工角膜提高了材料的生物相容性.     

Reconstruction of complex orbital fracture with titanium implants

AIM: To evaluate the effectiveness and safety of complex orbital fracture reconstruction with titanium implants. METHODS: A retrospective review of 46 patients treated with complex orbital fractures reconstruction using titanium implants from January 2005 to December 2008 was conducted. The following data were recorded: age, gender, mechanism of injury, preoperative and postoperative orbital CT, visual acuity, diplopia, ocular motility and Hertel exophthalmometer. RESULTS: The most common cause was motor vehicle accident (47.8%), followed by industrial injury (30.4%). All patients had improved appearance after operation and CT scan at one week after operation showed the fracture defects of orbit and neighboring areas had been reconstructed. Forty-six cases had various degrees of enophthalmos before operation. Among them, 32 cases were completely corrected, 11 cases improved obviously and 3 cases had no improvement after operation. Thirty-six patients with visual acuity ≥20/60 revealed diplopia of various degrees, including 26 patients had diplopia in right ahead and/or reading positions. At the sixth month after operation, diplopia disappeared in five patients, 7 patients still had diplopia in right ahead and/or reading positions, 14 patients had diplopia in positions rather than right ahead and reading positions (<20°) and ten patients had diplopia only at peripheral gazing (>20°). All patients had various degrees of ocular motility disorders before operation. At the sixth month after operation, eyeball movement disorder disappeared in 9 patients, 31 patients showed improvement and 6 patients had no improvement. Complications of implant infection, rejection and displacement were not reported after operation. CONCLUSION: The application of titanium implants in the repair of complex orbital fractures greatly improves the appearance and functional results, which is a favorable material for plastic surgery of complex orbital fracture.     

Clinical results of titanium retinal tacks with pneumatic insertion

We used titanium retinal tacks inserted with a pneumatic instrument for retinal fixation in 11 operative procedures in ten eyes with complicated retinal detachments. Titanium was selected for permanent implantation because of its documented biologic tolerance. No intraoperative or postoperative complications related to the tacks were encountered. Three tacks, one 0.7 mm in length and two 1.6 mm in length, became dislodged postoperatively; 50 permanently implanted tacks, each 1.6 mm in length, remained in place after a mean follow-up of five months. Retinal reattachment at the end of the follow-up period was achieved in eight eyes and useful visual function was obtained in three eyes. Titanium retinal tacks are useful when immediate retinal fixation is required either temporarily or permanently to prevent retraction and detachment of the retina until adjunctive diathermy, cryopexy, or photocoagulation becomes effective.     

A new titanium peg system for hydroxyapatite orbital implants

PURPOSE: To evaluate a new hydroxyapatite-coated titanium sleeve and titanium peg system for HA orbital implants. METHODS: The authors followed 54 patients receiving an HA-coated titanium sleeve and peg system and analyzed the complications associated with this peg system. The following data were recorded: type of surgery performed, size of implant used, type of HA used, time of pegging, follow-up duration, problems encountered, and treatment. RESULTS: Fifty-seven patients received the HA-coated titanium peg and sleeve system. The average duration of follow-up was 15 months (range, 3-30 months). Three patients were lost to follow-up after 1 month. Complications associated with peg placement in 54 patients included: discharge (9.2%), pyogenic granulomas (14.8%), peg falling out during prosthesis removal (9.2%), poor transfer of movement (1.8%), clicking (3.7%), conjunctiva overgrowing peg (1.8%), part of sleeve shaft visible (9.2%), peg drilled on an angle (1.8%), HA visible around peg hole (3.7%), and loose sleeve (3.7%). CONCLUSION: The HA-coated titanium sleeve and titanium peg is a new peg system available for HA orbital implants. Many of the complications associated with this peg system are similar to the commonly used polycarbonate peg system. Pyogenic granulomas and discharge, however, appear to be less frequently encountered with this new system. The HA-coated titanium sleeve and titanium pegs were well tolerated and appeared quieter in the socket than most polycarbonate pegs.     

医用钛合金义管在泪道重建中的临床应用

目的探讨医用钛合金义管在泪道重建中的临床应用和疗效。方法医用钛合金义管经泪囊行鼻泪管义管植入术治疗慢性泪囊炎患者28例（32眼），并进行1年的追踪观察。结果治愈率为90．6％，且保留泪囊和鼻泪管原有的解剖通道。结论该术式操作简单、效果好，并发症少。     

钛板与羟基磷灰石复合人工骨在眼眶重建中的应用研究

目的探讨应用钛板、羟基磷灰石复合人工骨矫正眼眶骨折的手术方法和疗效。方法根据术前CT诊断明确的25例（25眼）眼眶骨折术中用钛钉、钛板将复位的眶缘骨折进行坚强内固定，重建正常的眶缘，用羟基磷灰石人工骨材料植入眼眶，以填补眶腔容积的缺损，同时修复重建眶壁。结果术后随访3-12月，CT水平和冠状位扫描复查，眼球内陷的18眼中，17眼获得矫正，1眼仍存在中度内陷，再次手术后矫正。复视5例中，4例获得良好改善，1例无效，偶伴歪头。3例颧弓骨折，与口腔科联合手术后完全矫正。无植入物感染、移位和脱出，未见视力丧失者。结论钛板和复合羟基磷灰石人工骨具有很好的生物相容性，在眶壁重建手术中可获得满意的疗效，是眶壁重建术良好的替代材料。     

Accumulation of a black material around some titanium coupling posts

PURPOSE: To report 5 patients with a black material accumulating in the conjunctiva around the titanium peg and sleeve systems. METHODS: Retrospective small case series. The clinical features of 5 patients were reviewed. Histopathologic analysis was performed on specimens from 3 patients. Neutron activation analysis was performed on 1 sample. RESULTS: Five asymptomatic patients with black material accumulating in the conjunctiva at the conjunctival-titanium peg interface were evaluated. All patients had a hydroxyapatite-coated titanium sleeve with a titanium peg in position. Histopathologic analysis performed on specimens from 3 patients revealed a mixed inflammatory cell infiltrate with focal areas of a black, foreign-appearing material showing birefringence under polarized light that was predominantly intracytoplasmic. This black material did not respond to bleaching, and in 2 patients, it showed positive staining for iron (Perls method). The material from one patient was evaluated by neutron activation analysis and was found to contain titanium, aluminum, and vanadium. In 18 to 48 months of follow-up, the presence of the material did not appear to be associated with any problems. CONCLUSIONS: The presence of a black substance accumulating in the conjunctiva around some titanium coupling posts is uncommon and appears to be without any consequence in 18 to 48 months of follow-up. Our analysis revealed this substance to be consistent with titanium alloy (Ti-6Al-4V).     

Primary placement of a titanium sleeve in hydroxyapatite orbital implants

BACKGROUND: To study a new surgical option of primary placement of a titanium sleeve into hydroxyapatite implants during enucleation or evisceration. METHODS: A standard enucleation or cornea preserved evisceration was performed, followed by preplacement of a titanium sleeve into the hydroxyapatite implant by a hand drill sleeve driver. Care must be taken to ensure that the titanium sleeve is positioned centrally when the implant is put inside the orbital socket or eviscerated shell. The Tenon capsule and conjunctiva were meticulously closed with minimal tension. Complications such as sleeve exposure, coralline exposure, and infection of the titanium sleeve were closely observed. RESULTS: In all, 30 patients were treated in the above fashion with 10 enucleation and 20 evisceration procedures. The follow-up period ranged from 9 to 24 months. Three of the sleeves were found to have exposed spontaneously at 5 and 7 weeks following original surgery. They had no further complication except one sleeve loosening. The remaining 27 sleeves that did not spontaneously expose pursued secondary exposure of the titanium sleeve and peg insertion by conjunctival cutdown procedure 3 months after original surgery. Two sleeves were found to be oblique positioned after the conjunctival cutdown procedure. Fortunately, all the 30 patients were successfully fit with a peg-coupled prosthesis with good motility. CONCLUSION: Primary placement of a titanium sleeve into hydroxyapatite implants has several advantages, including high patient acceptance, technical simplicity, and office-based conjunctival cutdown pegging procedure. By avoiding the expense of postoperative imaging study and additional prosthetic modification, a more rapid and efficient rehabilitation is possible.     

Effect of titanium dioxide nanoparticles on zebrafish embryos and developing retina

AIM:To investigate the impact of titanium dioxide nanoparticles (TiO2 NPs) on embryonic development and retinal neurogenesis. METHODS:The agglomeration and sedimentation of TiO2 NPs solutions at different dilutions were observed, and the ultraviolet-visible spectra of their supernatants were measured. Zebrafish embryos were experimentally exposed to TiO2 NPs until 72h postfertilization (hpf). The retinal neurogenesis and distribution of the microglia were analyzed by immunohistochemistry and whole mount in situ hybridization. RESULTS: The1 mg/L was determined to be an appropriate exposure dose. Embryos exposed to TiO2 NPs had a normal phenotype. The neurogenesis was initiated on time, and ganglion cells, cones and rods were well differentiated at 72 hpf. The expression of fms mRNA and the 4C4 antibody, which were specific to microglia in the central nervous system (CNS), closely resembled their endogenous profile. CONCLUSION:These data demonstrate that short-term exposure to TiO2 NPs at a low dose does not lead to delayed embryonic development or retinal neurotoxicity.     

应用个体化预成型钛网修复眶下壁骨折的临床分析

目的：：探讨个体化预成型钛网修复眶下壁骨折的应用效果。方法：对下壁眼眶骨折患者共67例67眼采用个体化预成型钛网进行手术修复,术后随访期为1a,监测切口愈合情况、视力、眼球运动度、复视及眼球突出情况。结果：术后随访期间无感染,无钛网移位、脱出、变形及排斥等并发症,无下睑外翻病例发生。眼球内陷均达到双眼球突出度对比相差小于2mm。术后随访1a,所有患者眶下壁骨折全面修复。眼球运动无受限,各方向运动到位。复视者5例中复视完全消失4例,明显改善1例,2例眼球下移者下移均消失。术后视力与术前对比无明显变化。第一眼位复视消失率为93%,另外3例患者明显改善,周边视野复视消失率为86%,另2例患者明显改善。结论：应用个体化预成型钛网进行眶下壁骨折修复效果满意,安全性好。     

Experimental study on the biocompatibility of keratoprosthesis with improved titanium implant

AIM: To investigate whether hydroxyapatite (HAp) coating can improve keratoprosthesis (KPro) implant biointegration, ultimately to decrease the risk of implant-associated complications. METHODS: The modified titanium implant was designed and prepared for artificial cornea. The titanium implant was treated with sandblasting and hydroxyapatite coating by acid-base two-step method. Surface was analyzed by scanning electron microscopy (SEM), KPro implants coated with HAp and KPro implant sandblasted were implanted in rabbits. Tissue adhesion to the implant was assessed and compared to an unmodified implant by histopathology (HE), transmission electron microscopy (TEM) and SEM. RESULTS: SEM demonstrated successful deposition of HAp on titanium implant sandblasted (HA/SB-Ti). The hydroxyapatite coatings caused enhancement of keratocyte proliferation compared with unmodified implant surfaces. HAp coating significantly increased adhesion forces. HAp coating of implants reduced the inflammatory response around the KPro implants in vivo. CONCLUSION: HAp-coated surfaces for use in titanium KPro implant greatly enhanced adherence of the titanium KPro implant in the rabbit cornea.     

HA表面改性人工角膜钛支架生物相容性动物实验研究

目的 经羟基磷灰石(hydroxyapatite,HA)表面改性的三襻式人工角膜钛支架植入兔角膜板层探讨其与角膜组织的生物相容性及组织愈合情况.方法 24只新西兰白兔随机分为A、B、 C 3组,A组(9只)及B组(9只)分别于右眼角膜板层植入HA表面改性后的三襻式人工角膜钛支架(HA-Ti)及人工角膜钛支架(Ti);C组(6只)为手术对照组,仅制备囊袋不植入支架.观察人工角膜支架的生物相容性及新生血管生长情况,并分别于术后2周、4周、16周取材,行组织病理学及支架表面组织扫描电镜观察.结果 观察期间A、B组均未见角膜感染、溶解、支架排出.早期实验组角膜有水肿及新生血管长入,A组新生血管明显多于B组.组织学观察术后2周,A组炎症细胞浸润重于对照C组及B组(P<0.05);4周和16周时A、B和C组各组间炎症反应无明显差别(P>0.05).A组支架周围基质成纤维细胞增生显著,术后2周、4周A组和B组成纤维细胞增生均多于对照C组(P<0.05),且A组增生明显多于B组(P<0.05);术后16周时各组间差异无统计学意义(P>0.05).扫描电镜HA-Ti支架表面角膜组织黏附好,胶原纤维与支架连接紧密.结论 HA表面改性三襻式钛支架促进角膜血管化,有利于人工角膜的稳定,使人工角膜支架具有良好生物相容性及促进组织界面愈合能力.     

三维眶底重建钛网在复合性眼眶骨折中的应用

目的 探讨应用三维眶底重建钛网治疗复合性眼眶骨折修复眶底缺损的手术方法和临床效果.方法 回顾性系列病例研究.回顾性分析13例(13只眼)行三维眶底重建钛网植入眼眶骨折修复眶底重建手术的复合性眼眶骨折患者的临床资料.其中眶颧颌骨折6例,鼻眶筛骨折5例,眼眶四壁多发性骨折2例.术中联合行颧骨、上颌骨骨折、鼻骨以及额骨骨折修复,8例眼球重度凹陷的患者同时行高密度聚乙烯眶内充填.手术前后测量眼球突出度、眼球运动以及眼眶CT扫描(水平位、冠状位以及三维重建).术后随访3～6个月.结果 术前患眼眼球凹陷平均(3.9±1.7)mm,眼球下移(3.1±2.6)mm.13例患者中,12例存在眼球运动障碍,其中Ⅰ级有4例,Ⅱ级有7例,Ⅲ级有2例.术后除3例患者残存眼球凹陷1.0 mm,其余10例患者眼球凹陷矫正;8例患者眼球下移完全矫正,3例残留眼球下移1.0 mm,2例患者眼球上移1.0 mm;术后3个月后8例患者眼球运动受限完全矫正,其余5例眼球运动障碍减轻,其中残留Ⅱ级运动障碍2例,Ⅰ级运动障碍3例;随访过程中未发现三维眶底重建钛网移位、排斥、感染及其他不良反应.结论 三维眶底重建钛网具有良好的生物相容性,采用三维眶底重建钛网治疗复合性眼眶骨折,可有效恢复眼眶容积,矫正眼球内陷和下移,改善眼球运动.

Abstract：

Objective To evaluate the outcomes of the clinical application of three-dimensionally preformed titanium mesh plates for posttraumatic complex orbital bone fracture reconstruction. Methods Thirteen patients (13 eyes) manifested with complex orbital fractures (including orbital-zygomatic- maxillary bone fracture in 6 patients,nasal-orbital-ethmoid bone fracture in 5 patients and complex multiple periorbital bone fracture in other 2 patients ) underwent the reconstructive surgery by using three-dimensionally preformed titanium mesh plates. Eight cases underwent high density porous polyethylene implantation simultaneously. Evaluation of enophthalmos,eyeball movement,and orbit CT scan were taken pre- and post-operatively. Results The average enophthalmos was (3.9 ± 1.7 ) mm and the position of the affected eyeball was( 3. 1 ± 2. 6)mm bellow the contralateral side preoperatively. Twelve patients suffered from eyeball movement restriction,including grade Ⅰ in 4 cases,grade Ⅱ in 7 cases and grade Ⅲ in 2 cases. During the 3 to 6 months post operative follow-up,enophthalmos was completely corrected in 10 patients while the other 3 patients had residual 1.0 mm enophthalmos. The affected eyeballs were repositioned in 8 cases and 3 cases had residual 1 mm lower position and 2 cases with a 1 mm higher positioned eyeball. Eye movement was not restricted in 8 patients,whereas 3 patients had grade Ⅰ movement restriction and 2 patients had grade Ⅱ movement restriction. There were no rejection,infection and other complications during follow-up.Conclusions Three-dimensionally preformed titanium mesh plates can be used to reconstruct posttraumatic complex orbital bone fractures in order to improve the orbital volume and to correct enophthalmos effectively.     

应用AO三维预成型钛网治疗眼眶骨折的临床研究

目的：：评价三维预成型钛网在单纯性眶壁骨折修复中的精确性和可行性。方法：本研究共包括47例单纯性眶壁骨折患者,骨折部位如下：内下壁联合骨折26例(55%),单纯眶内壁骨折12例(26%),单纯眶下壁骨折9例(19%)。对于眶下壁骨折,采用标准的经下睑结膜入路;而对于眶内壁骨折和内下壁联合骨折,则采用经泪阜、经下睑结膜联合入路,同时暂时切断下斜肌将两切口沟通。所有患者均充分暴露骨折边缘并还纳疝出的眶内组织后,根据术前CT测量的骨折缺损范围,选择对应型号的AO三维预成型钛网并进行适当的修剪和弯制后植入眶内,使用两颗钛钉将钛网固定于眶下缘。通过术后复查眼眶三维CT来评价植入钛网的精确性,通过对患者术前和术后的临床资料的对比来评价预成型钛网临床应用的可行性。结果：术后CT表明,所有患者的眼眶骨折在植入三维预成型钛网后均得到比较精确的解剖修复。所有患者在术中、术后均未出现严重的并发症,40例(87%)患者眼球内陷得以矫正,25例(86%)患者复视消失。结论：AO三维预成型钛网在解剖上可比较精确地修复眶壁骨折;在临床上,可以显著改善眼球内陷和复视。