异种脱细胞真皮与异体巩膜作为HA义眼台包裹材料的实验研究

目的 观察异种脱细胞真皮（acellular xenogenic dermal matrix,X-ADM）和异体巩膜作为羟基磷灰石（hydroxy apatite,HA）义眼台包裹材料,用于实验兔眼的临床表现及病理组织学变化观察.方法 24只纯种新西兰兔,行一只眼的眼球摘除术后,随机平均分为实验组和对照组.于肌锥内分别置入由异种脱细胞真皮及异体巩膜包裹的HA义眼台.术后观察眼部表现,于1、2、4、6、8和12周,连同异种脱细胞真皮或异体巩膜取出义眼台,光镜下观察包裹材料与义眼台的组织病理学改变,包括炎症反应及血管化情况.取4、8和12周标本做透射电镜观察上述组织的超微结构改变.结果 与异体巩膜组相比,异种脱细胞真皮组在同期的成纤维细胞及新生血管的生长更活跃,而且长入较早,新生胶原形成丰富,几乎没有炎症细胞的浸润以及发生排斥反应.结论 异种脱细胞真皮血管化快,免疫原性低,是一种良好的巩膜替代物.     

同种异体脱细胞真皮替代同种异体巩膜在眼窝填充中的实验研究

目的 ①了解同种异体脱细胞真皮植入兔眼窝后的组织相容性。②比较两种不同材料包裹羟基磷灰石(hydmxyapatite，HA)植入的结果，包裹材料及HA的血管化进程。方法 随机将24只新西兰大白兔平均分为两组，于球后间隙内分别植入以同种异体巩膜、同种异体脱细胞真皮作为包裹材料的HA，观察大体情况并分别于植入后1、4、8、12周取出，光镜及电镜检查组织学改变。结果 大体显示同种异体脱细胞真皮组植入后无一例出现排斥，但其血管化速度较同种异体巩膜组缓慢。结论 同种异体脱细胞真皮作为包裹材料有较好的组织相容性。并能逐渐引导被包裹材料的血管化。     

自体巩膜包裹Ⅰ期羟基磷灰石义眼台植入治疗外伤后眼球破裂的疗效及预后分析

目的探讨自体巩膜包裹Ⅰ期羟基磷灰石(HA)义眼台植入治疗外伤后眼球破裂的疗效并分析预后。方法选取2012年6月至2017年6月期间在本院行HA义眼台Ⅰ期植入术的62例患者进行研究,随机分为观察组和对照组。研究组患者采用自体巩膜包裹Ⅰ期HA义眼台植入治疗,对照组患者采用异体巩膜包裹Ⅰ期HA义眼台植入治疗。比较两组患者术后治疗效果以及术后并发症发生情况。结果术后患者双眼外观均对称、饱满,义眼活动良好,可水平转动度约10°~30°,垂直约15°~20°,未出现义眼台脱出或移位现象。观察组并发症发生率为3.2%,均为球结膜水肿;对照组义眼台暴露的发生率为9.6%,球结膜水肿的发生率为3.2%,结膜肉芽肿的发生率为3.2%,总并发症发生率为16.1%。观察组的并发症发生率显著低于对照组,差异有统计学意义(P0.05)。结论自体巩膜包裹Ⅰ期羟基磷灰石义眼台植入治疗外伤后眼球破裂的疗效较好,手术安全可靠,术后并发症少,可在临床上推广。     

羟基磷灰石义眼台置入术的临床效果观察

目的:探讨羟基磷灰石(hydroxyapatite,HA)义眼台置入术的方法和临床疗效。方法:对37例病例资料进行回顾性分析,所有病例全部采用自体巩膜包裹义眼台置入方法,术后随访6～24个月,观察术后效果。结果:37例病例发生义眼台暴露1例,无HA义眼台排斥、感染、脱出、移位;无眶内感染及上睑下垂现象。结论:羟基磷灰石义眼台置入术的最严重并发症义眼台暴露,其原因较多,但主要与手术方式关系最为密切,我们认为最好采取自体巩膜包裹的Ⅰ期置入方式。     

羟基磷灰石眼座植入后暴露原因及其处理

目的：探讨羟基磷灰石眼座植入术后暴露的问题。方法：羟基磷灰石（HA）眼座植入术后暴露者15例，用不同方法进行治疗和观察。结果：眼座暴露多发生在5天-30天之内，暴露范围为2mm-13mm，其中8例自行愈合，7例进行手术处理。结论：HA眼座植入术后主要并发症是眼座暴露，其原因为HA眼座微孔缺乏纤维血管长入，眼座暴露可依其范围，大小采用不同方法处理，暴露范围为中度（≥6mm）以上时，应尽早手术处理。     

重度眼球萎缩患者巩膜腔HA植入术的临床研究

目的:探讨重度眼球萎缩患者巩膜腔HA植入的可行性.方法:眼轴直径在18mm以下的重度眼球萎缩患者76例(76眼),采用眼内容物去除后,切下直径14mm后巩膜,然后在巩膜腔内植入18～20mm HA眼台并在眼台前覆盖切下的后巩膜,再分层缝合角巩膜瓣筋膜结膜.结果:本组76例患者74例结膜创口Ⅰ期愈合,2例结膜切口裂开经保守治疗后愈合,术后随访6～22月,所有患者无感染、交感性眼炎及义眼台暴露,眼窝饱满,所配戴义眼活动度好,效果满意.结论:巩膜腔AH植入术仍然适合于重度眼球萎缩患者的容貌矫正.     

巩膜四瓣法包裹羟基磷灰石义眼台植入术的临床疗效观察

目的:巩膜四瓣法包裹羟基磷灰石义眼台植入术的临床疗效观察.方法:35例(35眼)患者行眼内容物剜除术后,鼻上下、颞上下方剪开巩膜,将巩膜分成4方瓣,剪断视神经,以视盘为中心,环行剪开后极部巩膜.自后巩膜孔前剪开巩膜近赤道部,巩膜腔后部呈4片张开.结果:术后随访3-27月,患者术后义眼座球体稳固,双眼对称,外观逼真,活动度:内转、外转达10°-15°,上转、下转达10°.无暴露、移位等发生.结论:巩膜四瓣法包裹羟基磷灰石义眼台植入术安全可行,操作简便,并发症少,义眼活动更满意,值得推广.     

羟基磷灰石眼座置入后暴露的临床分析及处理

目的：探讨分析羟基磷灰石眼座（hydroxyapatite,HA）置入后暴露的原因及处理。方法：对18例羟基磷灰石眼座（HA）置入后暴露的患者,用不同的方法进行治疗和回顾性总结分析。结果：眼座暴露多发生在7～30天,暴露范围在1～15mm,其中3例自行愈合,15例进行手术治疗。结论：义眼座暴露为HA义眼座置入术后较为严重的并发症,根据暴露范围大小,可采用不同方法处理,暴露范围为中度（＞5mm）以上时,应尽早手术。     

羟基磷灰石义眼台暴露的处理和预防

目的：修复较大范围的羟基磷灰石义眼台暴露。方法：将异体巩膜覆盖于义眼台表面，然后严密缝合球筋膜与球结膜，共治疗20例患者。结果：19例修复成功，1例未成功而取出义眼台。结论：应用异体巩膜修复义眼台暴露是有效的。     

透明质酸复合自体骨髓移植修复兔桡骨缺损

目的：观察透明质酸（HA）复合自体骨髓（BM）移植后诱导成骨的能力，探讨HA作为骨髓移植的细胞基质的有效性，方法：手术造成新西兰以侧桡骨中段10mm骨缺损，HA0.4ml和BM2.0ml混合后注入实验测，对照组注入BM2ml，术后2、4、6周处死动物，摄X线处观察骨缺损修复情况，并进行组织学观察，碱性成纤维细胞生长因子（bFGF）及单克隆抗体的免疫组化染色，结果：实验侧骨缺损的修复优于对照侧，早期在实验侧的bFGF含量明显高于对照侧（P＜0．05）。结论：HA具有良好的生物相容性，是骨髓移植的适宜的细胞外基质。     

Clinical analysis of hydroxyapatite orbital implantation after ocular trauma in 211 cases

Objective: To evaluate the therapeutic effects and complications of hydroxyapatite ( HA) orbital implantation on patients after trauma-related surgeries. Methods: Retrospective analysis was made from 211 cases (211 eyes) who underwent HA orbital implant placement after trauma-related enucleation or evisceration, including 68 cases of evisceration and primary HA implant placement, 77 cases of enucleation and HA implant placement wrapped with multi-windowed sclera, 66 cases of enucleation and HA implant placement free of wrapping. All the cases were followed up for 1-5 years to observe the therapeutic effects and major complications. Results: Five of 211 cases had wound dehiscence. Ten cases had HA implants exposure, including 1 case suffering severe orbital infection and requiring HA implant removal. The implants exposure incidences by the three surgical methods were from 1.30% to 10.06% and averaged 4.74%. Significant difference was found in late exposure incidence and total incidence from the three methods (x2 =13.372, P<0.01 and x2 =7.540, P<0.05). Two cases had shrinkage of the lower fornix. Enophthalmos occurred in 1 case treated by method 1 and was corrected by implanting porous polyethylene (Medpor) plate into the bottom of orbit. In 210 cases, the artificial eye moved well and the cosmetic results were satisfactory. Conclusions: Different surgical methods have their own merit and disadvantage. Enucleation and placement of HA implant wrapped with multi-windowed sclera has corroborated fewer complications than others.     

人脐带包裹羟基磷灰石义眼座的实验及临床观察

目的 探讨人脐带组织作为羟基磷灰石（ＨＡ）义眼座置入体的包裹材料的可行性和临床效果。方法 对１０只兔行眼球摘除术后将以人脐带包裹的ＨＡ义眼座置入其眶内，于置入术后１，２周及１，２，３，６，８，１０，１２，１４个月将眼座取出，作扫描电子显微镜观察。另对１５例（１５眼）无眼球的患者作脐带包裹ＨＡ义眼座置入术，观察其临床效果。结果 动物实验显示脐带与ＨＡ眼座及眶内组织粘连紧密，随着时间推移，越来越浓密的     

应用异种脱细胞真皮的眼睑原位重建术的实验研究

目的探讨应用异种(猪)脱细胞真皮施行兔眼睑原位重建术后的组织相容性,比较异种(猪)脱细胞与异体巩膜替代睑板后的组织转归。方法采用兔眼睑缺损动物模型,随机分别给予异种(猪)脱细胞真皮、兔异体巩膜施行眼睑原位重建术。活体观察动物术后和移植物情况,于术后1、2、4、6、8和12周,取带植片的眼睑,光镜下观察替代材料和自体睑板交界处的组织病理学改变,包括炎症反应、纤维血管化情况和融合情况;取4、8和12周标本做透射电镜观察上述组织的超微结构改变。结果光镜和电镜下二者反应类似,差异无统计学意义。组织学检查显示异种脱细胞真皮引起的免疫和炎症反应轻微。结论异种(猪)脱细胞真皮在植入兔眼睑后有较好的组织相容性,并可引导新生胶原的生长,起到替代睑板的作用。     

Experimental facial augmentation with hydroxyapatite cement

OBJECTIVE: To study the results of implantation of preformed hydroxyapatite (HA) disks and HA cement in onlay augmentation. METHODS: In this prospective study involving 16 adult New Zealand rabbits, HA disk and HA cement samples were implanted separately and together along the bony and cartilaginous nasal dorsum as well as over the supraorbital bone. Gross and histologic examinations of the implants were performed at intervals ranging from 3 to 24 months. RESULTS: There was no evidence of infection, adverse reaction, or implant extrusion in the 15 rabbits surviving the planned period. Grossly, all rabbits had prominent noses and supraorbital regions that were immobile on digital palpation. No measurable change in HA disk height and width was noted but there was a 15% decrease in height and width in the HA cement implant. Microscopically, preformed HA disks were found to be enclosed in a vascularized fibrous capsule. When disks were combined with HA cement, a vascular fibrous capsule was still noted around the implant but there was osteoconversion in the underlying cement layer. Used alone, HA cement underwent both osteoconversion and osteointegration. Neither the preformed HA disk with and without HA cement nor the HA cement alone elicited giant cell reaction or inflammatory changes. The HA cement alone was found to have microscopic fissures at the edges. CONCLUSION: This animal study suggests that preformed HA implants and HA cement, alone or in combination, can be used to augment the non-stress-bearing craniofacial skeleton.     

TISSUE ENGINEERING OF HIGH DENSITY POROUS POLYETHYLENE IMPLANT FOR THREE-DIMENSIONAL RECONSTRUCTION: AN EXPERIMENTAL STUDY

Three-dimensional defects have been reconstructed with carved and remodelled frameworks wrapped within vascular carriers. If sufficient vascular penetration can be established without any change in the size and shape of an implant, it will be possible to cover it with a skin graft and aesthetically important fine details can be obtained. To achieve this, we first prefabricated high-density porous polyethylene implant in rabbits. Secondly, we applied full-thickness skin grafts over the anterior surface of the prefabricated implant. The implants were placed and anchored underneath the superficial inferior epigastric artery and vein pedicle bilaterally. A total of 10 implants were prefabricated and then grafted in five rabbits. The implants were evaluated by perfusion scintigraphy and histological examination. Results showed that the implants were invaded by fibroneovascular tissue, and that this tissue, which can be transferred as a pedicled or a free flap, was sufficient to sustain a skin graft.     

羟基磷灰石/超高分子聚乙烯复合材料的组织相容性及骨传导性实验研究

目的　旨在证实羟基磷灰石 超高分子聚乙烯 (hydroxyapatite ultra highmolecularweightpolyethtlene ,HA UHMWPE)复合物具有HA的良好生物性能和骨传导性 ,又保留有超高分子聚乙烯的可塑性。方法　分别对 2 4只新西兰白兔行HA、HA UHMWPE、UHMWPE材料眶上缘置入 ,于术后 1、4、8、12周行大体、光镜组织学和电镜检查。结果　置入物无脱出、移位。组织学检查显示 ,HA组植入物在术后 1周即有新生血管长入和成纤维细胞活跃增殖 ,在术后 8周时可见骨细胞 ,术后 12周可见钙盐呈板状骨样沉积。而在HA UHMWPE组中材料的边缘反应同HA组。UHMWPE组在术后 1周有薄层纤维结缔组织包裹。电镜检查 ,在HA及HA UHMWPE组未见骨细胞 ,UHMWPE组见其包膜胶原纤维排列清晰。结论　HA UHMWPE复合物具有HA的良好生物活性及骨传导性 ,因此此复合物有望成为一种较理想的骨替代材料 ,尤其是眶骨整复的替代材料。     

Migration of polyethylene particles around stable implants in an animal model

The aim of this study was to test the hypothesis that a tight seal between bone and implant will eliminate the avenue of particle migration around stable implants. Three types of implants were used in rabbits (polished press-fit Ti-6Al-4V or plasma-sprayed hydroxyapatite [HA]-coated Ti-6Al-4V) or doughy stage polymethyl methacrylate (PMMA). Implants were placed in the condylar notch. Each animal received an intra-articular injection of high density polyethylene (PE) particles (10(8) in 0.4 mL; mean size 4.7 microns) at 4 and 6 weeks postoperatively. Eight weeks postoperatively, peri-implant tissues were examined for PE particles and osteolysis. In all cases, intracellular PE particles were seen at the bone-implant interface and within marrow. No osteolysis was observed. Bone apposition was determined by computerized image analysis. There was no significant difference in the percentage of bone apposition (+/- SD) among the three groups of implants: Ti-6Al-4V (68% +/- 19%), HA-coated Ti-6Al-4V (70% +/- 10%), and PMMA (59% +/- 12%). These results indicate that a polished Ti-6Al-4V surface is as effective as PMMA or HA coating in limiting migration of PE particles around stable osseointegrated implants in rabbits.