羟基磷灰石眼座植入及其并发症处理

目的观察眼球摘除或球内容剜出术后国产羟基磷灰石眶内植入的临床效果。方法１６例１６眼眼球摘除或眼内剜出术后均Ⅰ期或Ⅱ期植入国产羟基磷灰石眼座。结果随访观察３月至一年半，术后未出现义眼座感染和排斥反应。其中４例出现并发症，经处理效果满意。结论国产羟基磷灰石作为一种新型眶内植入物材料，临床效果满意     

羟基磷灰石义眼座植入12例的临床体会

目的观察羟基磷灰石义眼座术后的临床疗效．方法行眼球内容物剜除术，剪断视神经，于4条直肌间剪开巩膜，一期植入羟基磷灰石义眼座于巩膜腔及肌锥内．结果随访6-24个月，12例均植入成功，无义眼座排斥，暴露，感染等并发症．获得满意的外观康复效果．结论羟基磷灰石义眼座是理想的眼眶内填充物，眼内容物剜除术后植入义眼座，明显改善术后眼窝塌陷畸形刑于义眼安装，无严重并发症，是一种眼眶美容术中的理想方法．     

改良式羟基磷灰石义眼座植入的临床观察

目的 观察改良式羟基磷灰石义眼座植入的临床效果。方法 26例眼内容剜除后患者一期植入羟基磷灰石义眼座．义眼座置于四条眼外肌之间肌锥内，前有双层巩膜壳包裹。结果 术后所有病例随诊6个月～2年，术后上眶区均饱满，与对侧眼相比外观无明显差异，切口一期愈合，义眼活动良好，矫正外形满意，未发现其他并发症。结论 改良式羟基磷灰义眼座植入术并发症少，疗效满意，是较为理想的眼眶美容术式。     

改良式羟基磷灰石义眼座植入的临床观察

目的观察改良式羟基磷灰石义眼座植入的临床效果。方法21例眼内容摘除后行一期植入羟基磷灰石义眼座，巩膜花瓣样成形，义眼座植入巩膜壳内，前有双层巩膜壳包裹。结果术后所有病例随访6月～1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座植入术并发症少，疗效良好。     

改良羟基磷灰石义眼座植入104例临床观察

目的：观察改良式羟基磷灰石义眼座植入的临床效果。方法：眼内容剜除后，后极巩膜开窗直径10mm-15mm，剪断视神经，取出后极巩膜及视神经残端，一期植入羟基磷灰石义眼座入肌锥内。结果：随访4-23月，3例发生义眼座暴露，经异体巩膜移植修补后修复，所有病例义眼活动良好，矫正外形满意。结论：改良式羟基磷灰石义眼座植入术并发症少，疗效满意，是较为理想的眼眶美容术式。     

眼内容剜出后巩膜剖开羟基磷灰石义眼胎Ⅰ期植入术

眼内容剜出术后羟基磷灰石义眼胎 期植入对改善术后眼窝凹陷畸形能取得满意的效果 ,但常见方法 [1 ] 有操作复杂、巩膜张力较大、植入眼胎偏小、血管化进程较慢、术后可能出现眼胎排斥暴露、眼窝凹陷复发等缺陷。近年来 ,笔者在临床中应用巩膜壳斜形剖开联合羟基磷灰石义眼胎植入 ,手术方法简单 ,术后并发症少。现报告如下。一、资料和方法1.一般资料 :我院从 2 0 0 1年 1月至 2 0 0 2年 6月对 2 7例 (2 7只眼 )患者施行了眼内容剜出后巩膜剖开羟基磷灰石义眼胎 期植入术 ,其中男性 19例 ,女性 8例 ,年龄 19岁至6 4岁 ,平均 33.7岁。手术…     

伴有眼眶骨折的羟基磷灰石义眼座植入

目的 探讨伴眼眶骨折的羟基磷灰石眼座植入的方法。方法 对63例眼眶骨折的患者在植入羟基磷灰石眼座时根据CT及术中情况，对其中34例同时行眼眶骨折整复并垫Medpor或羟基磷灰石骨板，29例单纯眼座植入。结果 随访1～36个月，平均17．6月，无继发感染和植入物排出现象。3例单纯眼座植入及1例同时手术处理骨折者出现上睑轻度凹陷，其余病例放置义眼片后外观满意。结论 对外伤引起眼球破裂者，尤其是钝性外伤，应检查CT以确定有无骨折，再根据CT及术中情况决定是否处理骨折。     

改良式肌锥内羟基磷灰石义眼座植入术30例的临床观察

目的:观察改良式肌锥内羟基磷灰石义眼座植入术的临床效果。方法:眼内容物剜出术后,剪断外直肌和视神经,一期植入羟基磷灰石义眼座于肌锥内。结果:追踪观察6mo,所有义眼矫正的外形满意,活动度良好,无1例义眼暴露。结论:改良式肌锥内羟基磷灰石义眼座植入术并发症少,疗效满意,是一种理想的眼眶美容术。     

羟基磷灰石义眼座在儿童应用的临床报告

目的研究羟基磷灰石义眼座在儿童应用的必要性及安全性。方法采用新型假体材料－羟基磷灰石义眼座对眼球摘除的16例患儿分别行一期或二期植入，分析植入的羟基磷灰石义眼座的直径大小及与眼球摘除时间、患者年龄等的关系。结果16例手术均术后一期愈合，无感染、伤口裂开等并发症。植入物的直径大小与患儿的年龄、眼球摘除时间及结膜囊内是否安装义眼有密切关系。结论在儿童期行眼球摘除术后应一期植入义眼座，以保证眼眶骨的正常发育。同时，应该选用具有良好的生物及组织相容性的羟基磷灰石义眼座。     

珊瑚状羟基磷灰石义眼座的临床应用

６２例眼内容剜出或眼球摘除术后患者接受珊瑚状羟基磷灰石义眼窝内植入手术。叙述两种术操作过程并对手术方式进行了讨论。术后观察２－２４个月，平均１５．４，所有病例眼窝册陷得到矫正，外观满意，未见植入物感染、移位或脱出。     

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。     

眼外伤后二期眼球摘除义眼台植入后自体巩膜溶解原因

目的探讨眼外伤后二期眼球摘除义眼台植入后发生自体巩膜溶解的原因。方法对行眼球摘除患者病历资料进行回顾性总结和分析,根据是否斟眼外伤后一期缝合并在不同时间二期行眼球摘除义眼台植入分成两组,组1为眼外伤后二期眼球摘除义眼台植入164例（164眼）;组2为其余原因眼球摘除义眼台植入352例（352眼）。从一期眼球破裂情况、术后眼球炎症反应、二期眼球摘除原因、术后并发症、术后效果等方面进行分析,比较两组之间发生自体巩膜溶解的差异及可能的原因。结果外伤后二期眼球摘除义眼台植入术后自体巩膜溶解的发生率（8．54％）明显高于其它原因行眼球摘除义眼台植入者（1．99％）（x^2=12．868P〈0．001）。结论推测外伤后二期眼球摘除义眼台植入术后自体巩膜溶解发生的可能原因众多：二次植入的时间、义眼台排斥、多次手术激发了超敏反应及抗原抗体反应、外伤及手术大面积扰动致使眼球筋膜囊瘢痕粘连等。提示我们适时的选择眼球摘除义眼仃植人对预防术后发生自体巩膜溶解有助。,     

Mersilene mesh versus sclera in wrapping hydroxyapatite orbital implants

PURPOSE: To compare Mersilene mesh versus sclera in wrapping hydroxyapatite orbital implants used in primary enucleation. METHODS: In a prospective, randomized, interventional comparative case series, 60 eyes from 60 consecutive patients were included and randomly allocated for primary enucleation and either Mersilene mesh-wrapped hydroxyapatite (MHA) orbital implant (30 cases, 50%) or sclera-wrapped hydroxyapatite (SHA) orbital implant (30 cases, 50%) under general anesthesia. Complete socket examination was performed at 1 week, 1 month, and then every 3 months after surgery. RESULTS: Mean age was not significantly different (P = 0.08) between patients with MHA (36.43 years) and SHA (28.50 years) orbital implants. The most common cause of enucleation was trauma in both groups (P = 0.09). Patients with MHA had significantly (P = 0.005) longer follow-up time (mean, 11.40 months) than those with SHA (mean, 9.40 months). No exposure was found at last follow-up in the MHA group, but one patient in the SHA group had a small exposure (1 x 1 mm) 1 month after surgery that was conservatively treated. There were no significant postoperative soft tissue complications in either group. CONCLUSIONS: Sclera and Mersilene mesh could be used as a wrapping material for hydroxyapatite orbital implants without significant complications. Absence of disease transmission, low cost, and availability are the main advantages of Mersilene mesh.     

羟基磷灰石义眼座植入安装活动性义眼临床应用及疗效分析

目的观察羟基磷灰石义眼座植入安装活动性义眼的临床疗效。方法共54例（57眼）。其中眼球摘除、眼内容摘除义眼座植入43例（45眼）,二期植入11例（12眼）。行义眼座植入后安装活动性义眼。追踪观察10月～4年。结果54例（57眼）术后义眼水平活动度大于20°者29眼（50.88%）,活动度在10°～20°之间者22眼（38.59%）,活动度小于10°者6眼（10.53%）,并发症少。结论羟基磷灰石义眼座植入,安装活动性义眼,术后并发症少,活动度好。     

Primary banked scleral patch graft in the prevention of exposure of hydroxyapatite orbital implants

PURPOSE: The most frequently reported complication of hydroxyapatite orbital implantation is exposure of the implant, which may result in infection or extrusion of the implant. This study describes the use of banked sclera patch grafts to prevent implant exposure. DESIGN: A retrospective noncomparative interventional case series. PARTICIPANTS: The procedure was performed on 110 patients over a 2-year period. Hydroxyapatite implantation was performed either at the time of enucleation or as a secondary procedure to correct postenucleation socket syndrome. INTERVENTION: A banked scleral patch graft from the second eye of the same donor was placed over a scleral-wrapped hydroxyapatite implant at the time of operation. The case records were reviewed retrospectively. OUTCOME MEASURES: The primary outcome measure was the number of patients who developed exposure of their hydroxyapatite implant. The number of patients who had a postoperative conjunctival wound dehiscence was also recorded. RESULTS: No patients developed exposure of the implant. A significant percentage of patients developed conjunctival wound dehiscence (33%). Further surgery was not required in any of these cases, because the dehiscence spontaneously reconjunctivalized over the surface of the scleral patch graft. CONCLUSIONS: Insertion of a banked scleral patch graft at the time of hydroxyapatite orbital implantation is an effective means of preventing implant exposure, even in more complex cases. It thereby reduces the morbidity resulting from the procedure and obviates the need for further surgery when there is breakdown of the conjunctival wound postoperatively.     

Bovine pericardium (Tutopatch) wrap for hydroxyapatite implants

PURPOSE: To evaluate bovine pericardium (Tutopatch) as a wrapping material for hydroxyapatite implants in patients undergoing enucleation for uveal melanoma. METHOD: Prospective cohort study of patients who had enucleation for uveal melanoma between January 2003 and August 2003 were included in the study. Any patient with less than 3 months follow-up was excluded. Enucleation was performed under general anaesthesia followed by insertion of hydroxyapatite implants wrapped in bovine pericardium (Tutopatch). The recti muscles were sutured directly to the wrap. The tenon's capsule and conjunctiva were closed in two layers. A conformer was inserted at 1 week and artificial eye at 2-3 months. The patients were followed up regularly and were assessed for cosmetic result, exposure of implant, and the need for any further surgical procedures. RESULTS: A total of 19 patients (seven male and 12 female) were included in the study. Median age at diagnosis was 63 years (range 38-80 years). Median follow-up was 26 months (range 22-30 months). No patient developed postoperative complications of wound dehiscence. The overall cosmetic result was excellent in all the patients. The rate of postoperative complications compared favourably with published data using other wrapping materials/implants. CONCLUSION: Tutopatch is a safe wrapping material for hydroxyapatite orbital implants in patients undergoing enucleation for uveal melanoma.     

改良式羟基磷灰石义眼台I期植入临床分析

目的观察改良式羟基磷灰石义眼台植入的临床效果。方法20例（20眼）眼内容摘除后应用自体巩膜花瓣状成形、球内视神经剪断的方法包裹义眼台I期植人,交叉重叠缝合义眼台前的4瓣巩膜,后方巩膜敞开,分层缝合眼球筋膜囊及结膜。术后随访3～18月。结果所有患眼术后上睑饱满,与对侧眼相比无明显差异,切口I期愈合,义眼台活动良好,未发现义眼台暴露等并发症。结论改良式羟基磷灰石义眼台植入术安全可靠,并发症少,疗效良好。     

眼球摘除188例原因分析及义眼台植入的效果

目的对188例眼球摘除的原因进行分析，评价义眼台植入的效果。方法采用回顾性研究的方法，分析了眼球摘除的原因，并对眼球摘除的适应证及其并发症进行了讨论。结果眼球摘除的188例中，眼外伤93例，占49．47％；恶性肿瘤41例，占22．81％；失明伴眼痛、眼球萎缩及眼内炎等其他原因54例，占28．72％。其中义眼台植入76例，出现并发症者5例，包括2例结膜息肉，3例义眼台暴露。结论眼外伤是眼球摘除占首位的原因。眼球摘除后义眼台的及时植入，能改善外观，手术并发症少。     

眶内植入带线羟基磷灰石义眼座的临床分析

目的 探讨眶内植入带线羟基磷灰石（HA）义眼座的临床效果。方法 对85例（85眼）眼球摘除者眶内植入带线HA义眼座。结果 术后随访12-36个月,平均18个月。义眼座活动度良好。82例结膜创口Ⅰ期愈合,2例结膜变薄,1例结膜创口裂开,义眼座暴露。无眶内血肿或感染等并发症。结论 眶内植入带线HA义眼座手术操作简单,术后并发症少,美容效果佳,临床效果好。     

羟基磷灰石义眼座植入Ⅰ期钻孔的初步效果

目的 评价羟基磷灰石义眼座植入Ⅰ期钻孔放置钛钉的疗效。方法 对31例眼球摘除患者行Ⅰ期或Ⅱ期羟基磷灰石义眼座植入同时行钻孔,钻入钛钉的螺纹套子,中间放置平头钉,3～7个月后剪开,更换为球头钉,定制义眼片。结果 随访3．0～11．0个月(平均6．9个月),所有患者对义眼外观及活动度满意,无义眼座暴露、继发感染、栓钉脱出、栓钉偏斜等并发症。结论 羟基磷灰石义眼座植入Ⅰ期钻孔手术效果好,无明显增加并发症的发生机会,是一种可供选择的手术方法。