羟基磷灰石义眼台不同植入方法的效果评价

目的 评价羟基磷灰石义眼台不同植人方法的临床效果.方法 分为5组,分别采用一期植人、二期植入、自体及异体巩膜包裹或无巩膜包裹等不同方法植入羟基磷灰石义眼台183例183眼,随访3～24月.对其术后并发症及整容效果进行分析比较.结果 术后义眼台暴露24例,暴露面积≤5 mm者可自行愈合,暴露面积＞5 mm者多需要手术修复;各组所有病例眼窝饱满,双眼对称.一期植入术后眼球活动度优于二期植入者.结论 羟基磷灰石义眼台植入整容效果满意,术后主要并发症是义眼台暴露.条件允许的情况下首选义眼台一期植入;二期手术应尽早进行.     

羟基磷灰石义眼台眶内植入术及相应并发症的相关分析

目的 分析羟基磷灰石（HA）义眼台植入方式与术后义眼台暴露的关系及HA植入术中需注意的问题。方法 对38例患者的病例资料进行回顾性分析,其中采用无包裹HA义眼台直接植入24例;自体巩膜HA义眼台前双层覆盖或义眼台巩膜壳内植入14例。随访3-6个月。结果 采用无包裹HA义眼台直接植入24例中,5例发生义眼台暴露,发生率为20.8%;利用自体巩膜覆盖或包裹的方式14例中,仅1例发生暴露,发生率为7.1%。前者暴露发生率显著高于后者,经统计学分析有显著性差异（P〈0.01）。结论 HA义眼台植入术后主要并发症是眼台暴露,与多种因素有关,包括义眼座的选择,塑料眼模片的使用等,但术前选择手术方式尤其重要,Ⅰ期植入应尽量采取保留自体巩膜的方式。     

不同术式羟基磷灰石义眼座植入的临床观察

目的观察不同术式的羟基磷灰石义眼座植入的效果及并发症。方法35例病例随机分为无包裹组19例和自体巩膜包裹组16例,通过不同手术方法植入羟基磷灰石义眼座。随访3m～18m。结果术后眼窝饱满度、义眼座活动度良好。主要并发症为结膜囊裂开,义眼座暴露,无包裹组暴露原因与全身营养不良有关,自体巩膜包裹组暴露原因与巩膜自溶有关。结论不同术式羟基磷灰石义眼座植入术后的并发症原因各不相同,提倡直接植入无包裹义眼座。     

带和不带巩膜壳羟基磷灰石义眼台植入临床观察

目的比较不带巩膜壳和带巩膜壳羟基磷灰石义眼台植入术的疗效。方法30例不带巩膜壳羟基磷灰石义眼台植入者、30例带自体巩膜壳义眼台植入者、10例改良带自体巩膜壳义跟台植入者,术后随访1～10 a,对其疗效进行比较,以评价手术效果。结果30例带自体巩膜壳义眼台植入者,术后有5例发生肉芽肿形成,其中4例行义眼台取出术,1例经保守治疗痊愈。30例不带巩膜壳义眼台植入者有1例出现义眼台暴露。10例改良带自体巩膜壳义眼台植入者,无一例出现并发症。结论肉芽肿形成是带自体巩膜壳义眼台植入术后常见并发症,包裹的巩膜壳会影响义眼台血管纤维化,并发生融解和异物反应。改良带自体巩膜壳义眼台植入术可避免这一并发症,又可获得较好的美容效果。     

HA花瓣状巩膜壳内植入的临床研究

目的：探讨羟基磷灰石义眼台（HA）,Ⅰ期植入花瓣状巩膜壳内的手术效果。方法：对有眼球内容物剜除术适应证的病例,实施眼球内容物剜除术,依据眼B超和钢球模检测所需羟基磷灰石义眼台型号,将羟基磷灰石义眼台Ⅰ期植入花瓣状巩膜壳内,其表面双层巩膜覆盖。随访6～15mo,观察术后效果。结果：患者48例48眼均成功植入羟基磷灰石义眼台,并获得较满意的外观美容效果。结论：羟基磷灰石义眼台Ⅰ期植入花瓣状巩膜壳内术式,保留了眼球六条附属肌肉及其功能,义眼台前方自体巩膜双层覆盖防止眼台暴露,改善眼内容物剜出术后眼窝塌陷等畸形,达到较为理想的一种眼部整形效果。     

羟基磷灰石义眼台暴露与手术技巧相关性分析

目的：探讨不同方法进行羟基磷灰石义眼台植入的效果。方法：44例（44只眼）行不同方法的羟基磷灰石义眼台植入手术，随访1年以上。结果：行留置巩膜包裹羟基磷灰石义眼台手术方法23例，随访其中8例义眼台暴露，9例结膜囊退缩，结膜下可透见义眼台；行羟基磷灰石义眼台直接植入肌圆锥内手术法21例，术后半年随访无并发症，效果良好。结论：羟基磷灰石义眼台直接植入肌圆锥内，比留置巩膜包裹羟基磷灰石义眼台植放方法好，有明显的优越性。     

羟基磷灰石义眼台眶内植入术临床观察

目的 观察巩膜包裹羟基磷灰石义眼台植入法的临床效果.方法 用白体或异体巩膜包裹义眼台后眶内植入.Ⅰ期用自体巩膜植入12例,Ⅱ期用异体巩膜植入6例.结果 随访3月～2年,1例结膜囊狭窄,配置仿真义眼片困难,其余义眼活动良好,配戴仿真义眼片后眼外观满意.18例均无发生义眼台感染、排斥.结论羟基磷灰石义眼台眶内植入术,是眶美容的一种理想方法,自体巩膜包裹较异体巩膜包裹义眼台的义眼活动度及外观较好,尽量行Ⅰ期植入.     

巩膜原位覆盖羟基磷灰石义眼台植入临床观察

目的 探讨改良式巩膜内羟基磷灰石义眼台植入的临床效果.方法 22例(22眼)眼内容摘除后应用自体巩膜后开窗及前折叠包裹羟基磷灰石义眼台,术后随访3 ～ 15个月.结果 所有患者均有良好效果,无一例义眼台暴露,义眼台活动良好.结论 改良式羟基磷灰石义眼台植入术并发症少,疗效良好.     

带和不带巩膜壳羟基磷灰石义眼台植人临床观察

目的比较不带巩膜壳和带巩膜壳羟基磷灰石义眼台植入术的疗效。方法30例不带巩膜壳羟基磷灰石义眼台植入者、30例带白体巩膜壳义眼白植入者、10例改良带白体巩膜壳义跟台植入者，术后随访1—10a，对其疗效进行比较，以评价手术效果。结果30例带自体巩膜壳义跟台植入者，术后有5例发生肉芽肿形成，其中4例行义眼台取出术，1例经保守治疗痊愈。30例不带巩膜壳义眼台植入者有1例出现义眼台暴露。10例改良带自体巩膜壳义眼台植入者，无一例出现并发症：结论肉芽肿形成是带自体巩膜壳义眼台植入术后常见并发症，包裹的巩膜壳会影响义眼台血管纤维化，并发生融解和异物反应。改良带白体巩膜壳义眼台植入术可避免这一并发症，又可获得较好的美容效果。     

自体巩膜包裹羟基磷灰石义眼座植入术临床效果分析

目的探讨自体巩膜包裹羟基磷灰石义眼座植入术临床疗效及安全性。方法对21例眼球摘除的病人,进行Ⅰ期植入自体巩膜包裹羟基磷灰石眼座,矫正上眶凹陷等畸形。结果追踪6-12个月,植入HA眼座球体稳定,眼眶区饱满,义眼座活动度好,无严重的球体暴露及移位。结论自体巩膜包裹羟基磷灰石眼座植入,为安全可靠的眼窝成形术     

异形羟基磷灰石义眼台的临床应用

目的:观察异形羟基磷灰石义眼台植入术并发症及手术效果,探讨异形义眼台的适应证及其临床应用价值。方法:设计不同体积的异形羟基磷灰石义眼台,治疗眼球萎缩、眼内容物摘除及眼球摘除术后患者共30例。对照组植入常规圆球形羟基磷灰石义眼台共30例。异形义眼台组与对照组间性别、年龄、眼部情况相似。手术后随访时间6mo以上,观察患者义眼台植入术后球结膜愈合时间、义眼台暴露、感染等并发症、义眼台活动度、位置以及与义眼片适合程度的差异。结果:异形羟基磷灰石义眼台组没有发生义眼台暴露、感染等严重并发症,球结膜愈合时间短,义眼台植入后前表面呈圆弧形,能与义眼片很好的吻合,义眼台活动度及位置均好于对照组。对照组有2例(7%)发生早期球结膜裂开的并发症,经过治疗后均愈合。结论:异形义眼台可以降低义眼台植入后引起的并发症,可以有效适应患者眼部病变的情况,获得良好的手术效果,适应证更广,安全性更好。     

自体巩膜覆盖预防羟基磷灰石义眼座暴露的临床观察

目的：观察自体巩膜覆盖羟基磷灰石(HA)义眼座对预防术后义眼座暴露的临床效果。

方法：对69例69眼采用双层巩膜覆盖43例、带直肌的板层巩膜瓣覆盖26例为加固物,行一期HA义眼座植入术。

结果：术后随访4～24mo,均无义眼座暴露发生。

结论：在行HA义眼座植入时,双层巩膜、带直肌的板层巩膜瓣为加固物覆盖HA,能有效地预防义眼座暴露。     

脱细胞真皮包裹PHEMA水凝胶义眼台的实验研究

目的:研究脱细胞真皮包裹的水凝胶义眼台复合物的制备方法,评价其生物学性能。方法:材料制备:用MMA和HEMA的聚合物单体加入NaCl成孔剂制备多孔水凝胶义眼台,750mL/L乙醇浸泡制备同种异体巩膜包裹物。动物实验:新西兰白兔32只,右眼球摘除术后,16只植入脱细胞真皮包裹的直径为12mm的水凝胶义眼台作为实验组,16只植入保存异体巩膜包裹的直径为12mm的水凝胶义眼台作为对照组,术后在不同时间点(2,4,8,12wk)取材作病理检查,比较不同包裹材料对义眼台血管化程度和义眼台植入并发症发生率影响的差别。结果:MMA和HEMA的聚合物单体体积膨胀率为1.2,孔隙率为72%,孔径大小为450～520μm,且多为通孔。不同材料包裹PHEMA多孔水凝胶义眼台植入兔眶腔术后,所有32眼无肉芽肿发生及义眼台排出。光镜结果显示纤维血管组织2wk时从植入物外周长入,4～8wk时孔隙内胶原纤维逐渐致密,12wk时完成纤维血管化,扫描电镜显示植入物孔隙内逐渐被纤维血管组织填充,2wk时纤维血管组织附壁生长,12wk时孔隙内被纤维血管组织充满且孔间相连。对各组植入物纤维血管化程度进行测量,结果进行多因素方差分析,实验组较对照组血管化速度快(P=0.01)。结论:PHEMA水凝胶义眼台和脱细胞真皮生物相容性好,是一种安全可靠的眶内植入物,符合临床应用的要求,具有潜在的实际应用价值。     

Porous orbital implants, wraps, and PEG placement in the pediatric population after enucleation

PURPOSE: To investigate complications of various porous orbital implants and wrapping materials in the pediatric population after enucleation. DESIGN: A retrospective, comparative, nonrandomized study. METHODS: Between November 1992 and November 2006, patients younger than 15 years old were collected for study participation. They underwent enucleation with porous orbital implants primarily or secondarily at National Taiwan University Hospital. The authors used the hydroxyapatite (HA), Medpor, and Bioceramic orbital implant. The HA implant was wrapped with four different materials: donor sclera, Lyodura, porcine sclera, and Vicryl mesh. A part of HA implants and all bioceramic implants were wrapped with Vicryl mesh, added anteriorly with scleral patch grafts. All Medpor implants were unwrapped. RESULTS: Forty-seven cases had more than a two-year follow-up. The exposure rates according to implants and wraps were: donor sclera-wrapped HA (two of nine, 22%), porcine sclera-wrapped HA (three of three, 100%), Vicryl mesh-wrapped HA (one of five, 20%), and unwrapped Medpor (one of four, 25%). No exposure was found in four Lyodura-wrapped HA implants, and 22 Vicryl mesh-wrapped HA and Bioceramic implants with anteriorly scleral coating. The exposure rate was lower in cases with implants wrapped by our method and Lyodura than in those with implants wrapped by other materials (P < .001). Of 47 patients, 20 (42.5%) were fitted with peg-coupled prostheses and all had good prosthetic movements subjectively. CONCLUSIONS: Different types of implants and wraps resulted in various exposure rates in the pediatric population. The modified wrapping technique may prevent porous implants from exposure in children.     

新鲜羊膜联合唇黏膜移植治疗义眼座暴露的疗效观察

目的：探讨新鲜羊膜联合唇黏膜移植治疗义眼座暴露的手术方法及临床效果。

方法：对24例义眼座植入术后义眼座暴露的患者行新鲜羊膜联合唇黏膜移植,观察术后义眼座有无外露、感染。

结果：移植唇黏膜全部成活,眼座无外露,结膜囊无缩窄,患者基本满意。

结论：新鲜羊膜联合唇黏膜移植是治疗义眼座暴露的理想方法。     

Bovine pericardium versus homologous sclera as a wrapping for hydroxyapatite orbital implants

PURPOSE: To report our experience with bovine pericardium as a wrapping material for hydroxyapatite orbital implants after enucleation and to compare the exposure rates of the implants wrapped with bovine pericardium versus donor sclera. METHODS: We retrospectively reviewed the records of all patients who received bovine pericardium-wrapped or donor sclera-wrapped hydroxyapatite implant after primary enucleation between March 1995 and December 2001. RESULTS: Of the 26 patients who received donor sclera-wrapped implants after enucleation, 1 (3.8%) had implant exposure. Of the 26 patients who received bovine pericardium-wrapped implants after enucleation, 6 (23%) had implant exposure. The incidence of implant exposure with the use bovine pericardium wrapping material was found to be significantly higher than with sclera (P = 0.05). Six of the 7 implant exposures were noted in the first 6 months after placement of the orbital implant. Five of the 6 exposed bovine pericardium-wrapped hydroxyapatite implants were associated with socket infection. The case of exposure of the sclera-wrapped implant was treated conservatively by observation. Six patients who had exposure of bovine pericardium-wrapped implants required multiple repairs because of recurrent exposures. Four of these patients eventually required removal of the implant. CONCLUSIONS: Despite the advantages of using bovine pericardium as a wrapping material for hydroxyapatite orbital implants, we observed a significantly higher incidence of exposure with bovine pericardium compared with donor sclera in the early postoperative period. Use of bovine pericardium as a wrapping material for orbital implants should be avoided unless some future modifications of the technique can be developed to prevent such complications.     

Polytetrafluoroethylene as a wrapping material for a hydroxyapatite orbital implant

PURPOSE: Porous coralline hydroxyapatite orbital implants have been used with great success in anophthalmic sockets. We used a substitute for donor sclera as a wrapping tissue. METHODS: Orbital implants were wrapped with polytetrafluoroethylene (PTFE) instead of homologous donor tissue in five patients after enucleation. RESULTS: The postoperative course was uneventful in three cases. Complications occurred in two cases: one with implant exposure, and one with severe implant infection leading to its eventual removal. CONCLUSIONS: PTFE is inferior to other wrapping tissue.     

改良自体巩膜帽状扣盖术在羟基磷灰石义眼台植入术中的应用

目的观察改良自体巩膜扣盖术对自体巩膜较小者行羟基磷灰石(HA)义眼台植入术的临床效果。方法对10例(10眼)眼球萎缩和6例(6眼)眼内容摘除术后有自体巩膜但仅能包裹义眼台1/4~1/2者,将自体巩膜呈帽状包盖固定于义眼台前极后植入肌锥内,再与肌肉止端缝合。结果本组16例中有14例结膜创口一期愈合,2例结膜切口裂开经保守治疗2周后自愈。术后随访3月~3年,无发生感染、义眼台暴露及交感性眼炎等并发症者。所有患者义眼活动良好,美容效果理想。结论改良HA义眼台植入术安全可靠,适用于自体巩膜较小者。     

羟基磷灰石义眼台植入的手术体会

目的比较巩膜包裹羟基磷灰石(hydmxypatite，HA)义眼台植入法与带线HA义眼台直接植入法的疗效。方法眶内植入HA义眼台共58眼，用自体或异体巩膜包裹义眼台后眶内植入40眼，用带线义眼台直接植入眼眶18眼，随访3月-4年。结果义眼台暴露7眼12％(7／58)，Ⅰ期1眼，Ⅱ期6眼；6眼采用巩膜包裹植入法15％(6／40)，1眼采用带线义眼台直接植入法5．6％(1／18)。结膜囊狭窄1眼。结论HA义眼台植入术后主要并发症是义眼台暴露，用带线义眼台直接植入发生这种并发症的机率变小。     

羟基磷灰石义眼台植入术的临床观察

目的观察羟基磷灰石义眼台植入术的疗效。方法观察43例行义眼台植入术病例,其中Ⅰ期手术33例,Ⅱ期手术10例,收集各病例的临床资料、手术指征、义眼台大小、手术方式、手术疗效和术后并发症。术后随诊1—12个月。结果本组43例接受羟基磷灰石义眼台植入,全部病例均获得成功,术后随访无义眼台暴露、脱出、眼窝凹陷或上睑下垂,义眼活动度好,与健眼同步。无交感性眼炎发生。结论在严格掌握手术时机和手术指征,选择正确的手术方式和义眼台大小,正确处理术后并发症,羟基磷灰石义眼台植入术是一种安全而有效的治疗严重的眼球破裂伤、部分无光感疼痛性眼球或萎缩眼球的方法。