羟基磷灰石义眼台植入不同手术方法的效果比较

目的评价羟基磷灰石义眼台植入不同手术时机和不同手术方法的效果。方法对21例(21眼)采用不同手术方法分别行HA义眼台Ⅰ期植入16例,Ⅱ期植入5例。其中巩膜腔内植入8例,肌锥内植入13例。结果术后随访3~24月,平均12月。21例术后外观均获得了预期的改善,巩膜腔内Ⅰ期植入优于肌锥内Ⅰ期植入者;巩膜腔内Ⅰ期植入优于Ⅱ期植入者。同时与较小直径义眼台相比,植入直径较大(22 mmHA)义眼台,无论是巩膜腔内或肌锥内植入,其术后活动度、眼睑饱满度及外观均更为满意。无HA脱出和眼睑塌陷,均达到了比较好地临床效果。结论HA义眼台植入在手术时机的选择上Ⅰ期手术比Ⅱ期手术效果好;在手术方法的选择上巩膜腔内植入比眼眶肌锥内植入效果好;在义眼台大小的选择上,较大者术后眼睑的饱满度、活动度均优于直径HA较小者。     

羟基磷灰石义眼台植入26例的临床观察

目的:观察羟基磷灰石(hydroxyapatite,HA)义眼台两种植入手术方法的治疗效果.方法:回顾性分析我院2007-06/2011-06植入HA义眼台26例26眼患者资料,分别采用直接肌锥内植入法、巩膜后肌锥内植入法2种手术方法.术后随访3～24(平均13)mo.结果:所有患者中有15例手术后整形效果良好,出现结膜囊狭窄、肉芽肿、上眶区凹陷6例,义眼活动不良3例,仅有2例发生义眼台脱出.HA义眼台植入后义眼活动度和稳定性好.结论:HA义眼台植入术是无眼球患者的首选,而巩膜后肌锥内植入法能明显降低手术后义眼台暴露率.     

带眼外肌的自体巩膜壳覆盖羟基磷灰石义眼台植入术

目的观察带眼外肌的自体巩膜壳覆盖羟基磷灰石（HA）义眼台植入术的临床效果。方法54例（54只眼）无视功能者行眼内容物剜除后,采用带眼外肌的自体巩膜后肌锥内HA义眼台一期植入,术后观察术眼结膜的愈合、结膜囊深浅、HA义眼台位置及活动度等。结果术后随访4个月至2年,术后效果优50只眼（92．59％）,良4只眼（7．41％）,所有术眼结膜愈合好,未出现HA义眼台或巩膜暴露、感染,无义眼台移位,安置薄型义眼片后外观逼真,转动功能良好,眼窝饱满,双眼外形基本对称。结论肌锥内带眼外肌的自体巩膜壳覆盖HA义眼台植入术保留了完整的巩膜层、眼外肌和邻近的结缔组织,可以避免或最大限度的减少HA义眼台暴露的发生,术后义眼台运动度良好。     

三种羟基磷灰石义眼台植入术对比研究

目的:观察不同方式植入羟基磷灰石(HA)义眼台的临床效果。方法:对27例患者根据眼部的不同条件,分别以全巩膜壳内植入,后巩膜开窗巩膜壳内植入+前端巩膜修补式及巩膜壳后肌锥内植入等方法植入义眼台,并对其进行比较。结果:三种术式义眼台活动度有明显差异。1,2种巩膜壳内植入术后眼球活动度最好且并发症少。结论:义眼台巩膜壳内植入能明显缩短手术时间,且术后眼球活动度好,能获得较理想的仿真效果。肌锥内植入活动度差,仅1例出现义眼台暴露。     

羟基磷灰石义眼台Ⅱ期眶内植入术术式的探讨

目的 探讨羟基磷灰石义眼台Ⅱ期眶内植入术的最佳手术方式。方法 对18例(18眼)眼球摘除(或眼内容摘除)术后1周至33年的患者采用羟基磷灰石义眼台Ⅱ期眶内植入，观察其疗效。其中无自体巩膜者15例中的7例采用异体巩膜包裹义眼台植入肌锥内；另8例不用异体巩膜包裹而直接将义眼台植入肌锥内。有自体巩膜者3例，在剪断外直肌及视神经后，将义眼台从颞侧植入肌锥内(巩膜壳后)。结果 术后眼眶及眼睑外观满意，义眼活动度良好，义眼台眶内固定，术后随访5～36月，除异体巩膜包裹的1例发生排斥反应而取出义眼台外，其余无发生义眼台移位、脱出或眶内感染者。结论 Ⅱ期羟基磷灰石义眼台直接植入眶内，比用异体巩膜包裹植入眶内，操作简便、术后无排斥反应、效果更好。     

羟基磷灰石义眼台植入52例效果分析

目的:探讨羟基磷灰石(hydroxyapatite,HA)义眼台植入在眼科整形美容手术中的临床应用。 方法:对52例52眼患者采用不同的手术方式行HA义眼台植入。A组:自体巩膜壳内Ⅰ期植入24例24眼;B组：双层巩膜帽覆盖义眼台肌锥内Ⅰ期植入16例16眼;C组：异体巩膜包裹义眼台Ⅱ期植入12例12眼。 结果:术后随访3～24mo,大部分患者植入义眼台后眼球饱满,并获得一定的眼球活动度(优71.2%;良19.2%;差9.6%)。 结论：HA是当前理想的眶内植入物,应用于临床可以收到满意的效果。     

有无巩膜包裹HA义眼台植入术临床对比观察

目的 探讨有无巩膜包裹HA植入术的临床效果.方法 对眶内植入HA义眼台29例,其中有自体巩膜包裹HA义眼台13例,无巩膜包裹义眼台16例,随诊3个月至3年.结果 全部病例效果均良好,均Ⅰ期愈合,未见严重并发症及排斥反应,眼部整形效果理想.结论 无巩膜包裹HA直接植入肌锥中的方法简捷,是一种安全可靠的手术方法,值得推广.     

羟基磷灰石义眼台植入术临床应用

目的探讨眼球摘除或眼内容剜除羟基磷灰石义眼台植入术临床应用。方法眼内容剜除,后巩膜开窗,羟基磷灰石义眼台植入巩膜腔或肌锥内,分层紧密缝合巩膜、筋膜及结膜。结果2例2眼义眼台轻度外露,观察随访半年无发展,后行羊膜移植后愈合,其余21例21眼均无结膜裂开及义眼台外露,取得了满意的效果。结论眼内容剜除后一期植入义眼台于巩膜腔或肌锥内,术中充分降低巩膜、筋膜及结膜的张力,并紧密分层缝合是降低和预防结膜裂开,义眼台外露、脱出的关键。     

保留眼外肌的羟基磷灰石义眼台巩膜腔植入术66例

正0引言羟基磷灰石义眼台植入术方法繁多,义眼台肌锥内植入,义眼台外包自体巩膜或异体巩膜肌锥内植入及其多种变法。上述手术方法均要切断上下内外直肌,将4条直肌的断端缝合在义眼台上,重新构建义眼台的转动功能。我们设计了保留眼外肌的义眼台麻花状巩膜腔内植入方法,经过5a的临床观察取得满意结果,现报道如下。1临床资料总结2006-03/2010-03行羟基磷灰石义眼台麻花状巩膜植入术66例     

眼内容摘除术后羟基磷灰石义眼植入术式分析

目的：力求选择一种效果肯定，并发症少，较为理想的眼内容摘除术后羟基磷灰石（Hydroxyapatite HA)义眼植入方法。方法：对67例眼内容摘除术后HA义眼植入术，按HA植入方式的不同分为3组：（1）HA巩膜旁压入法；（2）HA巩膜鞘内植入法；（3）直视下HA肌锥内植入法；对其术式特点及近远期并发症进行比较。结果：3种术式的近远期并发症的发生情况不同，肌锥内植入法并发症少。结论：直视下HA肌锥内植入方式值得推广。     

羟基磷灰石义眼座眼窝植入两种术式的比较

目的 观察应用不同术式时羟基磷灰石义眼座的效果。方法 27例分为两组，分别采用巩膜包裹义眼座眶内植入法和直接植入肌锥中的方法。结果 共完成27例(27眼)，随访3—24月，手术效果良好。其中3例术后早期发生结膜伤口裂开，但未出现义眼座外露。结论 羟基磷灰石义眼座是眼窝填充术的理想材料。直接植入肌锥中的方法较简捷。     

儿童羟基磷灰石眼窝植入的临床研究

目的 评价儿童眼球摘除术后羟基磷灰石眼座眼窝植入的疗效。方法 采用自体巩膜或异体硬脑膜包裹羟基磷灰石作为眼窝植入物，观察56例的疗效，其中36例眼球摘除后Ⅰ期植入，20例Ⅱ期植入，6例钻孔放置栓钉。结果 随访1-78月，无眼座暴露、眶内感染或植入物排异、移位等并发症，外观满意。钻孔后放置栓钉者活动佳，未钻孔者活动稍差。结论 儿童羟基磷灰石眼座眼窝植入并发症少，能促进眼眶的正常发育，有助于儿童的身心健康成长。     

Problems with the hydroxyapatite orbital implant: experience with 250 consecutive cases.

The coral derived hydroxyapatite sphere is a popular, integrated orbital implant designed to provide improved motility of the ocular prosthesis following enucleation. Although the implant has rapidly become widely used by ophthalmologists, little information is available regarding the problems of this technique in a large series of cases. Experience with 250 consecutive cases of hydroxyapatite orbital implant use was reviewed and the problems of the implants and their management investigated specifically. The reasons for enucleation included uveal melanoma (157 cases), retinoblastoma (70 cases), blind painful eye (22 cases), and intraocular medulloepithelioma (one case). Earlier treatment to the eye was performed before enucleation in 47 cases and included repair of ruptured globe (17 cases), plaque radiotherapy (18 cases), external beam radiotherapy (six cases), and others (six cases). During a mean of 23 months' follow up (range 6-40 months), there have been no recognisable cases of orbital haemorrhage related to the implant, and no cases of implant extrusion or implant migration. There was one case of presumed orbital infection (culture negative) that resolved with intravenous antibiotics and the implant was retained within the orbit. Other problems included conjunctival thinning in eight cases managed by observation and prosthesis adjustment, and conjunctival erosion in four cases managed by combinations of scleral patch graft, conjunctival flap, and prosthesis adjustment. The conjunctival erosion was caused by a poorly fitting prosthesis in three cases and wound dehiscence in one case. The problem rate in eyes receiving prior radiotherapy or surgery was not increased. The hydroxyapatite integrated orbital implant is a well tolerated motility implant without the high rate of extrusion and infection seen with other motility implants. The prosthesis fit may contribute to the tolerance of the implant.     

羟基磷灰石义眼座眶内植入139例分析

目的探讨带预置缝线的羟基磷灰石(hydroxyapatite，HA)义眼座直接植入眶内的手术效果。方法自1997年9月～2002年6月进行带预置缝线的HA义眼座直接植入眶内手术139例(139眼)，其中Ⅰ期眶内义眼座植入117眼，Ⅱ期眶内义眼座植入22眼。随访6～24月，平均11．8月。结果139眼术后出现轻微眼睑及球结膜水肿，4眼结膜切口裂开，经保守治疗自愈。2眼HA义眼座暴露，经修复后愈合。随访观察139眼义眼活动良好，眼窝饱满；Ⅰ期较Ⅱ期植入的义眼活动度大，外观更逼真。未发生义眼座脱出及感染等并发症。结论眼球摘除术后植入HA义眼座，提高了眼球运动效果和面部美观程度，效果较好。     

眼内容摘除羟基磷灰石义眼座植入术96例疗效观察

目的 探讨Ⅰ期或Ⅱ期眼内容摘除羟基磷灰石义跟座植入术的手术效果.方法 对96例(96眼)Ⅰ期或Ⅱ期行眼内容摘除、经眼球内视神经断离、自体巩膜成形、羟基磷灰石义眼座植入术,跟踪观察10-24月.结果 术后眼睑轻度肿胀,球结膜水肿,眼眶区胀痛,仅2例球结膜切口裂开,经保守治疗愈合.无义眼座暴露、脱出及感染,交感性眼炎等并发症.结论 此术式符合眼球及眼肌生理解剖,手术方便易行,并发症少,术后义眼座球体稳定,眼眶饱满,活动度好,外观逼真.     

带预置缝线的羟基磷灰石义眼座眶内植入术疗效观察

目的探讨带预置缝线的羟基磷灰石义眼座(hydroxyapatite,HA)直接植入眶内的手术效果。方法22例(22只眼)行带预置缝线的羟基磷灰石义眼座直接植入眶内手术,术后随访3~17月。结果22只眼术后均有眼睑轻度肿胀,球结膜水肿,眼眶区胀痛,2只眼球结膜切口裂开,经保守治疗后愈合。未发生义眼座暴露、脱出及感染等并发症。结论带预置缝线的羟基磷灰石义眼座眶内植入术方便易行、疗效可靠。     

The quasi-integrated porous polyethylene orbital implant

PURPOSE: To describe a new quasi-integrated porous polyethylene orbital implant that combines the advantages of host tissue incorporation and improved motility with a single-stage surgery. METHODS: Twenty-four consecutive patients undergoing primary or secondary orbital implantation received the quasi-integrated porous polyethylene implant. Approximately 6 weeks after implantation, a custom-fitted prosthesis was made by an impression technique to provide a "lock-and-key" fit with the orbital implant. Postoperative complications and motility of the prosthetic shell were evaluated. RESULTS: During the 27-month period between December 1998 and March 2001, 24 patients received the quasi-integrated porous polyethylene implant as a buried orbital implant. Thirteen patients received the implant as a primary orbital implant after either evisceration or enucleation and 11 patients received the implant as a secondary orbital implant. Follow-up ranged from 3 months to 30 months, with an average of 16.9 months. All patients were considered to have good motility of their prosthetic shell at their final follow-up visit. No cases of implant extrusion or migration were noted. Two patients required deepening of their inferior fornix to accommodate the increased motility of their prosthesis. CONCLUSIONS: The new quasi-integrated porous polyethylene orbital implant provides improved motility without the need for secondary placement of pegs or screws. It has the advantage of biocompatibility, allowing host tissue incorporation to resist implant migration and extrusion. The implant is available in three sizes: small, medium, and large, approximating the volume of a 16-, 18-, and 20-millimeter sphere, respectively.     

Wrapping hydroxyapatite orbital implants with posterior auricular muscle complex grafts

PURPOSE: To report the use of posterior auricular muscle complex grafts as a wrapping material for hydroxyapatite orbital implants in enucleation surgery. METHOD: In a retrospective multicenter study, autogenous posterior auricular muscle complex grafts were used to cover hydroxyapatite orbital implants in 83 patients with a mean age of 38.6 years (range, 1 to 85 years), of whom 63 had primary unilateral enucleation and 20 had secondary orbital implants following enucleation. The mean follow-up period after posterior auricular muscle complex grafts was 36 months (range, 14 to 60 months). RESULTS: Of the 83 patients, two (2.4%) developed limited orbital implant exposure, which was treated with a second posterior auricular muscle complex "patch graft." No patient developed postoperative orbital infection or implant extrusion. All patients were fitted with an acceptable prosthesis and had satisfactory cosmetic and functional results. No patient developed vascular compromise or a wound defect associated with the posterior auricular donor site. CONCLUSION: Autogenous posterior auricular muscle complex grafts should be considered as an appropriate wrapping material for hydroxyapatite orbital implants for primary enucleation and for secondary orbital implants after enucleation.