眶骨延长术治疗眼球突出的实验研究

目的 探讨眶骨延长术扩大眶容积治疗眼球突出的可行性。方法 1年龄山羊6只，环行截开右侧眶壁，于眶上壁放置延长器，侧向延长1．5cm,经大体、X线、干骨标本及组织学观察成骨情况。结果 6只山羊眶骨得到不同程度的侧向延长，延长侧随着眶骨容量的增加，眼球突度较自身对照侧为小。结论 眶骨延长术可造成山羊眶骨侧向移位，有可能成为治疗眼球过度突出的方法之一。     

眶骨骨折继发眼球内陷的外科治疗

目的　对眶骨骨折进行分类 ,明确导致眼球内陷的原因并采取相应的手术治疗 ,提高眼球内陷畸形的手术矫治效果。方法　所有患者术前常规X线片、眶部轴面及冠面CT检查。根据检查结果 ,将眶骨骨折主要分为两型 :Ⅰ .单纯眶壁骨折 ,眶缘完整。此类骨折的部位主要发生在骨壁薄弱的眶底及眶内壁。Ⅱ .构成眶骨的骨骼骨折移位造成的眶骨的破裂。多见于眶颧骨折和鼻筛眶骨折。对Ⅰ型骨折所导致的眼球内陷畸形经下睑睫毛缘下切口入路 ,采用自体骨或人工骨材料置入修复 ;Ⅱ型骨折所造成的眼球内陷首先将移位的骨折块截骨复位、小夹板坚强内固定 ,重建正常的眶缘并采用自体或人工材料置入同时修复眶壁。结果　自 1996年 7月 - 2 0 0 0年 10月 ,共治疗眼球内陷畸形患者 5 2例 ,其中Ⅰ型 10例 ,Ⅱ型4 2例。眼球内陷畸形均明显矫正。结论　眶骨骨折所造成的后期眼球内陷畸形主要是因为眶骨骨性容积增大所造成的眶内容物与眶骨骨性容积失衡的结果 ,可通过植骨的手段修复眶骨各壁的缺损、缩小扩大的眶腔、重建眶骨正常的解剖形态和眶容积而得以有效的矫正。     

先天性小眼球小眶窝的眶缘截骨扩眶术

先天性小眼球不仅有碍患者的视觉功能 ,且常伴有其他畸形 ,严重影响外观。我院对 3例先天性小眼球伴小眶窝者行眶缘截骨扩创术 ,同时行羟基磷灰石义眼座置入和结膜囊成形术 ,效果满意 ,现报告如下。一、手术方法2 %利多卡因和 0 .75 %布比卡因各 5ｍｌ,加 0 .0 5ｍｇ肾上腺素 ,麻醉球后、眶上、眶下及面神经眼支。置开睑器 ,水平剪开结膜 ,分离结膜下组织及 4条直肌 ,直肌分别用 3 0丝线做双套环缝线 ,并在止点处剪断。摘除眼球 ,压迫止血 ,外眦角向外水平切开皮肤 2 0ｍｍ ,由眶上切迹处向外做眉弓切口与外眦水平切口相连。分离皮下组织、…     

眶骨骨折的手术矫治

总结了６年来所行５１例眼球尚存的眶骨骨折畸形的手术治疗经验。包括男３４人、女１７人。我们认为：术前的仔细检查、拍Ｘ线片及ＣＴ，据以制定手术方案；手术采用冠状切口或附加睑下缘切口；到达眶上缘后在骨膜下剥离，松解嵌顿的软组织，使眼球复位；显露眶骨缺损处，取肋骨充填；将断裂移位的内眦韧带复位固定等步骤，是保证手术后外形功能改善的关键。     

眶骨骨折的手术矫治

总结了6年来所行51例眼球尚存的眶骨骨折畸形的手术治疗经验。包括男34人、女17人。我们认为:术前的仔细检查、拍 X 线片及 CT,据以制定手术方案;手术采用冠状切口或附加睑下缘切口;到达眶上缘后在骨膜下剥离,松解嵌顿的软组织,使眼球复位;显露眶骨缺损处,取肋骨充填:将断裂移位的内眦韧带复位固定等步骤,是保证手术后外形功能改善的关键。     

眶骨骨折的手术矫治

总结了６年来所行５１例眼球尚存的眶骨骨折畸形的手术治疗经验。包括男３４人、女１７人。我们认为：术前的仔细检查、拍Ｘ线片及ＣＴ，据以制定手术方案；手术采用冠状切口或附加睑下缘切口；到达眶上缘后在骨膜下剥离，松解嵌顿的软组织，使眼球复位；显露眶骨缺损处，取肋骨充填；将断裂移位的内毗韧带复位固定等步骤，是保证手术后外形功能改善的关键。     

眶周分块截骨术在眶颧部骨折导致的眼球错位病例中的运用

目的探讨运用眶周分块截骨术治疗因眶颧部骨折所致眼球错位的可行性及效果。方法 26例单侧非爆裂性颧骨骨折患者的眶颧部移位骨块被截成两部分,将参与构成眼眶外下部的骨块向内上移位、固定以重建眼眶,对于不影响眼眶重建的移位骨块不作截骨复位。结果术后眼眶容积及眼球凸度得到有效改善,23例眼球位置显著改善,3例眼球凹陷症状部分纠正。术后随访1年,眼球位置及眼眶形态满意。结论眶周分块截骨术较传统的截骨术式操作简单,术中剥离范围小,可以恢复眼眶的生理解剖结构,并可有效矫正因眶颧部骨折所致的眼球错位。     

多孔聚乙烯外科种植体眶内填充治疗眼球异位

眼球异位是外伤后眶壁骨折畸形的常见后遗症,眼球复位对患者视觉功能及外观的改善有重要意义.自1997年10月以来,应用多孔聚乙烯外科种植材料行眶内填充矫正眶周骨折后眼球异位畸形9例,手术效果良好,术后6个月随访无排异,吸收,移位等情况.该材料组织相容性好,术中能根据临床要求塑形,机体组织能长入其多孔间隙中增加材料稳定性,与以往多种眶内填充材料相比具有多种优点.     

多孔聚乙烯外科种植体眶内填充治疗眼球异位

眼球异位是外伤后眶壁骨折畸形的常见后遗症 ,眼球复位对患者视觉功能及外观的改善有重要意义。自 1997年 10月以来 ,应用多孔聚乙烯外科种植材料行眶内填充矫正眶周骨折后眼球异位畸形 9例 ,手术效果良好 ,术后 6个月随访无排异 ,吸收 ,移位等情况。该材料组织相容性好 ,术中能根据临床要求塑形 ,机体组织能长入其多孔间隙中增加材料稳定性 ,与以往多种眶内填充材料相比具有多种优点     

经结膜入路扩大眶腔轻度眼球突出矫正术

目的 探索经结膜入路扩大眶腔治疗眼球轻度突出的手术方法,以改善患者外观.方法 采取眼球内侧结膜入路,沿眶内侧壁骨面向深部眶尖处剥离眶内侧壁的筛骨板,深可达2.5～3.0 cm,上下分离骨面宽约2.0～2.5 cm,使筛骨板骨折压缩筛窦扩大眶腔.2006年6月至2008年4月手术3例.结果 3例患者手术均获成功,术后半年随访双侧眼球活动均正常,无复视和视力减退,面部无皮肤瘢痕.结论 眼球内侧结膜入路剥离筛骨板扩大眶腔是治疗眼球轻度突出的有效方法.     

Huge orbital teratoma with intracranial extension: a case report

The authors present an unusual case of huge orbital teratoma extended to the cranial fossa in a newborn baby. The clinical features, radiologic findings, and surgical approach are described. Discussion will focus on the surgical technique and on the sparing of the affected eye, comparing the authors approach with other few cases described in literature. Finally, detailed histopathologic finding is provided.     

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.     

Hydroxyapatite orbital implant covered with fascia lata in post-enucleation eye reconstruction

The loss of an eye is a highly traumatic event, with severe psychological and physical implications. From November 1996 to June 2002, 32 patients underwent eye enucleation and placement of a hydroxyapatite orbital implant wrapped in autologous fascia lata; this was then fixed to the four rectus muscles. Motility was noted in all reconstructed sockets, without implant related complications. The immediate post-operative period was uncomplicated and all patients were discharged within 48 to 72 h after surgery. The orbital implant remained well positioned without dehiscence and motility was satisfactory. The follow-up ranged from 8 months to more than 5 years.Presented at the 14th Annual Meeting of the European Association of Plastic Surgeons (EURAPS), Vienna, Austria, 29–31 May 2003     

显微联合手术治疗复杂性眼外伤的临床分析

目的 探讨显微联合手术治疗复杂性眼外伤的方法及临床疗效。方法 应用显微手术包括开放创口修补、前房成形、白内障摘除、玻璃体切除、眼内异物摘除及视网膜复位，治疗复杂性眼外伤1429眼。结果 术后矫正视力提高者1249眼(87．4％)，视力无提高者180眼(12．6％)。三联及三联以上手术803眼(56．2％)，其中术中视网膜脱离复位率100％，眼内异物摘除成功率100％。结论 采用显微联合手术治疗复杂性眼外伤能同时处理多个合并症，减少患者多次手术痛苦，同时可提高临床疗效。     

非单纯性眼眶骨折的手术治疗

目的回顾性分析总结手术治疗非单纯性眼眶骨折的临床经验。方法2010年1月至2017年12月,中国医科大学附属第一医院整形外科收治的587例眼眶骨折患者,男性455例,女性132例,年龄19~65岁。术前根据临床表现和3D-CT检查结果进行诊断和评估;术中充分松解还纳嵌顿的软组织、复位眼眶、放置置入体;术后比较眼眶外形、眼球功能及3D-CT等评价手术效果。结果本组587例,术后均获10个月至2年随访,所有患者术后外形和功能均得到整体的改善或恢复。12例术前眼球内陷明显,术后仍有轻度内陷;9例仍有轻度眼球运动受限、复视部分恢复;除眼球破裂摘除患者,其余患者视力较受伤前均无明显下降。结论眼眶骨折需严格依据临床表现和3D-CT检查结果进行诊断和评估,及早地进行精确复位、固定、修补,可提高治疗的效果。     

Improvement of vision after a combined midfacial and maxillary distraction with a rigid external distraction Device

We report a rare case of visual improvement in a 19-year-old patient with Apert syndrome after segmental distraction with a rigid external distraction device. We used the Rigid External Distraction Device II System (R.E.D. II, KLS Martin) after Le Fort I and III osteotomies.     

Muscle response to leg lengthening during distraction osteogenesis

Continuous lengthening of intact muscles during distraction osteogenesis leads to an increase of sarcomeres and enhances the regeneration of tendons and blood vessels. A high distraction rate leads to an excessive leg and muscle lengthening and might cause damages of muscle fibers with fibrosis, necrosis, and muscle weakness. Complications like muscle contractures or atrophy after postoperative immobilization emphazize the importance of muscles and their function in the clinical outcome. In an animal model of distraction osteogenesis, 18 sheep were operated with an external fixator followed by 4 days latency, 21 days distraction (1.25 mm per day) and 51 days consolidation. The anatomical location (gastrocnemius, peroneus tertius, and first flexor digitorum longus muscle), dimension and occurrence of muscular defects were characterized histologically. The callus formation and leg axis was monitored by weekly X‐rays. Additionally, serum creatine kinase was analyzed during a distraction and consolidation period. Significant signs of muscle lesions in all three observed muscles can be found postoperatively, whereas normal callus formation and regular leg axis was observed radiologically. The peroneus tertius and first flexor digitorum longus muscles were found to have significantly more signs of fibrosis, inflammatory, and necrosis. Creatine kinase showed two peaks: 4 and 39 days postoperative as an indication of muscle damage and regeneration. The study implicates that muscle damages should be considered when a long‐distance distraction osteogenesis is planned. The surgeon should consider these muscle responses and individually discuss a two‐stage treatment or additional muscle tendon releases to minimize the risk of muscle damages. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 27: 483–488, 2009     

持续弹性外牵引矫正乳头内陷

目的 探索一种行之有效的、微创的乳头内陷矫正方法。方法 用钢丝、弹簧和塑料注射器制成弹性可调式的乳头内陷矫治器，利用弹性牵引作用，持续牵拉内陷乳头3～6个月。结果 14例患者均得以矫正，并获得良好的近期效果。1例患者因左侧乳头内陷严重，治疗2周时钢丝接近脱出乳头而更换矫治器并延长佩戴时间。随访患者6～12个月。效果稳定。结论 弹性可调式乳头内陷矫治器用于先天性乳头内陷的治疗，近期临床效果较好，为目前较佳的非手术治疗乳头内陷的方法，但其机理和远期效果还需进一步研究和观察。     

肌电图检查对颈椎间盘突出症的诊断价值

目的：颈椎间盘突出症为临床常见病,为准确定位依断,我们采用由单一脊神经后支支配的颈棘间肌等颈部深层肌群肌电图检查法,对颈椎间盘突出症患者进行定位诊断。方法：对３４例经临床和影学检查确认为颈椎间盘突出的患者,进行颈部深层肌肌电图测定。结果：与临床及影像学诊断的符合率９７％。颈部深层肌异常电位３３例,其中失神经电位２８例,阳性率８２．３％。Ｃ５－６椎间盘突出为其肌电图异常电位发生率也最高。结论：异常电