国产羟基磷灰石眼座植入术临床分析

目的：探讨眼球摘除或眼内容物剜出术后羟基磷灰石（HA）眼座植入术的临床效果。方法：42例患者分别行Ⅰ期和Ⅱ期羟基磷灰石自体巩膜包裹虹内植入术或肌圆锥内义眼座植入术。结果：随访观察半年,术后未出现义眼座感染,其中3例义眼座暴露。结论：国产羟基磷灰石眼座是一种理想的眶内植入材料,临床效果满意。     

羟基磷灰石义眼台植入矫治眼窝畸形

目的观察羟基磷灰石义眼台植入术矫治眼窝畸形的临床效果。方法对32例（32眼）采用羟基磷灰石义眼1期植入，其中巩膜腔内植入20例，肌锥内植入12例。结果采用此方法矫治眼窝畸形32例（32眼），均获得良好效果.结论羟基磷灰石义眼台是理想的眼窝填充材料，此手术方法简单，符合眼球运转功能，达到了眼窝整形与美观的效果。     

羟基磷灰石义眼台植入108例效果观察

目的 对羟基磷灰石义眼台植入术进行观察,评价义眼台植入的临床效果.方法 108例羟基磷灰石义眼台植入术患者中Ⅰ期植入87例,Ⅱ期植入21例.其中采用无包裹羟基磷灰石义眼台直接植入10例;自体巩膜壳内植入79例;异体巩膜壳内植入19例.随访3月～3年.结果 108例术后早期均有不同程度眼睑及结膜水肿,但随加压包扎去除逐渐消退.4例羟基磷灰石义眼座暴露,1例不影响效果,未处理,2例经再次充分分离筋膜组织,无张力缝合后愈合,1例暴露直径＞10 mm,经2次穹隆结膜松解重新缝合后愈合.Ⅱ期植入3例出现结膜囊狭窄,经成形后恢复;1例眼外肌无法充分暴露,术后义眼活动部分受限.其余107例义眼活动良好,配戴仿真义眼片后眼外观满意.结论 羟基磷灰石义眼座植入术式操作简单,美容效果佳.Ⅰ期较Ⅱ期植入义眼活动度及外观好,尽量行Ⅰ期植入,但术前手术方式选择尤其重要,Ⅰ期植入应尽量采取保留自体巩膜的方式,Ⅱ期植入时异体巩膜壳内植入优于无包裹义眼台直接植入.     

国产羟基磷灰石义眼座植入术临床观察

我院自1998～2003年采用国产羟基磷灰石义眼座对32例患者进行了Ⅰ期眶内植入术，术后效果满意，现报告如下。     

巩膜包裹与巩膜后肌锥植入义眼座临床探讨

目的探讨巩膜包裹和巩膜后肌锥植入2种不同手术方式I期植入羟基磷灰石(HA)义眼座进行手术方式及其术后常见并发症。方法34例患者随机按就诊先后秩序分为对照组13例(13眼)采用巩膜包裹法植入HA义眼座,观察组21例(21眼)采用巩膜后肌锥植入法植入HA义眼座。结果随访3~24个月,对照组中2例伤口裂开,移植唇黏膜及羊膜后愈合,1例术后3个月义眼座暴露,2例水平运动不足(<10°)。观察组中水平运动不足2例,未发现结膜裂开和义眼座暴露现象。结论I期羟基磷灰石义眼座植入手术中巩膜后肌锥植入法优于巩膜包裹法植入。     

巩膜腔内羟基磷灰石义眼胎植入术临床研究

目的研究探讨巩膜腔内羟基磷灰石义眼胎植入术的临床效果。方法选取我院收治的眼眶肿瘤患者32例作为研究对象,所有患者均进行义眼植入手术,将32例患者随机分为两组,每组16例。观察组患者采用巩膜腔内羟基磷灰石义眼胎植入术,对照组患者采用肌圆锥内羟基磷灰石义眼胎植入,对照观察两组患者的临床效果,并对患者进行术后随访,对照两组患者的术后并发症发生情况。结果观察组患者行巩膜腔内羟基磷灰石义眼胎植入术,筋膜囊和球结膜愈合良好,且结膜囊深度理想。安装仿真义眼之后,义眼活动良好。术后随访无义眼胎暴露或者脱出的情况出现。对照组患者术后有出现3例义眼胎暴露的情况。总之,行巩膜腔内羟基磷灰石义眼胎植入术的临床效果显著,术后并发症发生率低,且P<0.05,具有统计学意义。结论巩膜腔内羟基磷灰石义眼胎植入术的临床效果好、术后并发症少、美观性好,具有推广意义。     

96例羟基磷灰石义眼座眶内植入术疗效观察

[目的]探讨羟基磷灰石义眼座眶内植入的临床效果. [方法]行眶内容物摘除术后,以自体巩膜双层覆盖为加固物行羟基磷灰石义眼座植入术.[结果]仅2例球结膜切口裂开,经保守治疗愈合.无义眼座暴露、脱出及感染等并发症.[结论]此手术方式符合眼球及眼肌生理解剖,术后并发症少,义眼座球体稳固,义眼座活动好,眼眶饱满,疗效可靠.     

羟基磷灰石义眼台植入术的护理

目的 探讨羟基磷灰石义眼台植入术的护理.方法 对34例眼球摘除或眼内容物剜出术后,采用羟基磷灰石义眼台植入,认真做好心理护理、并发症的观察及义眼片的护理.结果 术后随访3～6个月,无羟基磷灰石义眼台脱出或移位,34例义眼活动好.结论 做好羟基磷灰石义眼台植入术的围手术期护理,对促进手术成功和患者康复具有重要的价值.     

改良羟基磷灰石义眼台一期植入的临床观察

目的：评价改良义眼台一期植入术的临床效果。方法：将50例患眼以4条直肌附着点为中心，劈下约213厚度板层巩膜瓣，将HA义眼台植入带板层巩膜瓣的肌圆锥内，板层巩膜瓣缝合覆盖于义眼台前方，进行I期植入。结果：术后所有病例随访1年～3年，术后上眶区饱满，与对侧眼相比无明显差异，切口一期愈合，义眼活动良好，矫正外形良好，未发现其他并发症。结论：改良式羟基磷灰石义眼台一期植入术并发症少，疗效良好。     

1例羟基磷灰石义眼座取出术患者围术期疼痛管理的实施

疼痛是伴随现有的或潜在的组织损伤而产生的生理和心理因素复杂结合的主观感受。疼痛管理是护士的一项基本职责,护士在疼痛管理中的重要作用越来越受到医护人员的一致认同。羟基磷灰石义眼座植入术可解决眼窝凹陷外观,但其严重并发症羟基磷灰石义眼座暴露也可带来严重疼痛。义眼座暴露的处理可药物观察处理,也可行结膜修补术,同时有少数患者疼痛难忍,要求行羟基磷灰石义眼座取出术。我院眼科收治了1例行羟基磷灰石义眼座取出术的患者,并实施了围手术期疼痛管理与护理,现报告如下。     

眶壁骨折整复联合眼球内容物去除义眼台植入术在眼整形中的临床应用效果

目的:探讨眶壁骨折整复术联合眼球内容物去除义眼台注入术在眼整形中的临床应用效果。方法:选取本院2016年1月~2017年1月收治的5例眶壁骨折伴发眼球破裂伤的患者,伤后早期行眶壁骨折整复术联合眼球内容物去除义眼台植入,分析手术方法,研究术后康复效果。结果:5例患者术后均伴有眼眶胀痛、眼睑轻度肿胀、球结膜水肿症状,术后3d症状缓解;术后随访2年,无义眼台外露,患者术后眼窝饱满,美观度满意。结论:在眶壁骨折眼球摘除术后整形中应用羟基磷灰石义眼台植入方案能够获得满意的外观效果,治疗安全性可靠,值得推广。     

Conservative therapy frequently indicated in blow-out fractures of the orbit

The results of the conservative approach in the management of patients with orbital blow-out fractures were studied at the Orbital Centre, Amsterdam. In 54 out of 111 patients with a pure blow-out fracture, high resolution CT was performed. In these 54 patients with diplopia, clinical examination together with the analysis of direct multiplanar high resolution CT revealed four cases of impaired motility. These were oedema, oculomotor nerve palsy, enophthalmos and adhesions around the lower eye muscles and the orbital floor. Patients were immediately instructed to exercise eye movements thoroughly. If diplopia did not resolve, further management was decided on. In all patients with edema or oculomotor nerve palsy, diplopia resolved spontaneously. Surgery was necessary to reduce diplopia in the enophthalmos and adhesion groups. This study shows that eye movement exercises together with a 'wait and see' approach diminish the number of operations by 50% in patients with pure blow-out fractures. It also circumvents the iatrogenic adhesions between eye muscles and orbital floor, which are difficult to treat.     

多层螺旋CT扫描及三维重建技术在眼外伤中的应用

目的探讨螺旋CT扫描及三维重建技术在眼外伤中的诊断价值。方法回顾性分析无锡市人民医院5年来就诊的57例（58只眼）眼外伤的螺旋CT检查资料。结果57例眼外伤中,39例为眼眶外伤,18例为眼球外伤,包括眶骨骨折、眶内血肿、眶内积气、眶内软组织伤、眼球伤、晶状体脱位、玻璃体出血和眶内及球内异物等,CT定位定性准确率100％。结论螺旋CT扫描及三维重建技术对眼外伤有重要的诊断价值。     

急性闭角型青光眼合并白内障的治疗方法和临床疗效分析

目的：探讨分析急性闭角型青光眼合并白内障的两种不同手术治疗方式和I临床疗效。方法：选取2008年1月一2011年6月来本院进行治疗的急性闭角型青光眼合并白内障患者,选择房角开放大于1／4象限者共80例,随机平均分为两组,实验组进行小切15白内障摘除术＋人工晶状体植入术＋虹膜根切术,对照组进行小切15白内障摘除术＋人工晶状体植人术＋小梁切除术,术后随访6个月,记录早期及6个月后的视力、眼压、前方深度等情况,统计比较两组的并发症发生情况。结果：两组术后早期视力、眼压、前房深度差异无统计学意义（P〉O．05）,6个月后,因眼压升高造成视力下降者,实验组2只眼,对照组3只眼,两组间差异无统计学意义（P〉O．05）。两组术后并发症的发生差异无统计学意义（P〉O．05）。结论：急性闭角型青光眼合并白内障的两种手术效果均良好,均值得临床推广应用。     

Ophthalmopathy in early thyrotoxicosis--relationship to thyroid receptor antibodies and effects of treatment

A prospective study of 25 newly diagnosed thyrotoxic patients was undertaken to determine the incidence and severity of ophthalmopathy in the early stages of the disease. A quantitative analysis of the ocular muscle changes was made using B scan ultrasonography, and the effects of treatment for the thyroid disease on the course of the eye changes was assessed. Although the majority (75%) of patients showed only mild clinical signs of ophthalmopathy (Werner Class 3 or less), 92% had ultrasonographic evidence of ocular muscle enlargement. Clinical involvement of the extraocular muscles was seen in 12% of the cases. There was an inverse correlation between the serum level of thyroid stimulating hormone receptor antibody (TR Ab) and the size of the extraocular muscles. Recovery of the euthyroid state with treatment was accompanied by a decrease in orbital infiltration in some cases, both clinically (reduced amplitude of intraocular pressure rise on elevation of the globe) and by ultrasonography, but the improvement was not statistically significant.     

One-stage reconstruction of the eye socket with vascularized temporalis muscle flap in orbital exenteration

AIM: Two cases of one-stage reconstruction of exenterated orbit with vascularized temporalis muscle flap in oncological patients are presented. The anatomical characteristics of the temporalis muscle flap and the choice of one-stage or delayed reconstruction of the exenterated orbit are discussed. METHODS: Two patients were operated for malignancy recurrence during the period May-November 2000. One patient suffered recurrent squamous cell carcinoma in the left nasolabial region that infiltrated the lower eyelid and periorbit. The other patient had recurrence of previously operated primary rhabdomyosarcoma of the orbit. Both patients underwent orbital exenteration. In the first patient it supplemented the tumor excision and partial maxillary excision resulting in large orbitomaxillary defect communicating with the nasal meatuses. RESULTS: In both patients good filling effect and isolation of the orbit from the neighbouring nasal meatuses and cranial cavity were obtained using vascularized temporalis muscle flap. CONCLUSION: The vascularized muscle flap appears a reliable technique and method of choice in one-stage as well as in delayed reconstruction in orbital exenteration.     

Compressed Air Injury of the Eyeball

Six cases of eye injury due to compressed air blast are reported in gasoline station attendants. The effect was varied — first degree burn of the eyelids, conjunctival and subconjunctival hemorrhage, traumatic mydriasis, posterior displacement of the iris diaphragm, traumatic retinal detachment, and orbital emphysema. The left eye was the one affected in all six cases. The nature of the lesion depended on the distance of the compressed air hose from the eye and the state of the eyeball prior to trauma.     

DSA定位下不同原因食管气管瘘内支架置入的临床应用

目的:分析DSA定位下不同原因食管气管瘘内支架置入的临床应用效果.方法:选择2012年1月~2017年1月进入我院的食管气管瘘患者21例作为研究对象,采用DSA定位下进行支架置入,分析置入效果.结果:21例研究对象其中20例一次性置入成功,支架膨开良好,对比通过顺畅,术中无大出血、食管穿孔等并发症发生.所有患者均在术后出现不同程度胸骨后疼痛,经临床对症处理后2~5天后续缓解.1例未成功置入患者瘘口仍存在,术后2个月死于肺部感染.另外20例其中2例在支架置入后32天出现大出血,经过积极抢救仍死亡.其余18例随访发现进食梗阻等临床症状得到明显改善,但5例因多器官功能衰竭死亡.结论:在DSA定位下对不同原因食管气管瘘内采用支架置入可获得良好临床效果,但是仍然需要根据患者个体情况选择合适类型和直径的支架.