巩膜花瓣状成形羟基磷灰石义眼座植入术疗效观察

目的 探讨巩膜花瓣状盛开有羟基磷灰石义眼座植入术的手术效果.方法 22例行有包裹无预置缝线的巩膜花瓣状成形HA植入术,随访3～17月,观察术后效果.结果 22例中术后1例结果菲薄,巩膜缝线外露,1月后重新缝合盘腊结腊治疗后愈合.1例结膜囊狭窄.未发生义眼座暴露、脱出及感染等并发症.结论 巩膜花瓣状成形羟基磷灰石义眼座植入术术后并发症少,义眼座活动好,手术方便易行、疗效较可靠.     

花瓣式巩膜成形包裹义眼台的临床应用

目的探讨花瓣式巩膜成形包裹国产羟基磷灰石（HA）义眼台在眼内容摘除术中的应用体会。方法对48例眼内容摘除者行花瓣式巩膜成形包裹国产HA义眼台植入术,术后随访6—24个月,观察手术效果。结果48例中仅有2例出现轻度结膜囊狭窄,所有病例均未发现义眼台暴露、脱出或感染等严重并发症。结论巩膜花瓣式成形包裹国产HA义眼台植入术方便易行,术后并发症少,义眼台活动佳,疗效好。     

巩膜花瓣状成形IOI义眼座植入观察

目的：观察巩膜花瓣状成形，美国IOI珊瑚羟基磷灰石义眼座植入后的疗效。方法：观按察分析23例行眼内容物剜除术后接受珊瑚羟基磷灰石义眼座眶内植入手术患的效果和并发症。结果：23例患均未发生眼座暴露、移位、义眼固定及感染。结论：巩膜花瓣状成形IOI义眼座植入术是治疗眼球内容物剜除术后眼窝塌陷、上睑凹陷畸形的理想方法。     

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。     

羟基磷灰石义眼座两种不同术式植入的临床效果观察

目的观察两种不同术式植入羟基磷灰石(HA)义眼座的手术效果。方法对38例(38只眼)行眼球内容物剜除术的患者随机分组,A组:21例(21只眼)采用巩膜花瓣状成形义眼座植入术。B组:17例(17只眼)采用巩膜帽状扣盖义眼座植入术,观察两组术式的疗效和远期并发症,随访6~24个月。结果随访期间38例患者术后义眼座活动灵活,眼窝饱满,无义眼座暴露及感染等并发症的发生。结论对于眼内容物剜除的患者,采用巩膜花瓣状成形义眼座植入术或是巩膜帽状扣盖义眼座植入术,均能获得良好的效果。两种术式损伤均小,简便易行,术后并发症少,值得推广。     

两种不同术式义眼台Ⅰ期植入方法的比较

目的观察不同术式羟基磷灰石义眼台Ⅰ期植入的临床效果。方法对23例患者采用两种不同术式Ⅰ期植入羟基磷灰石义眼台，植入方法分别为眼球摘除联合自体巩膜包裹义眼台植入术及眼内容物剜除联合巩膜花瓣状成形义眼台植入术。结果23例患者术后均无义眼台脱出及暴露等严重并发症，但术式一的术后反应偏重，义眼活动性稍差，术式二的眼球较术前偏小。结论两种术式各有其优缺点及适用范围，均能取得较满意的临床效果；但术式二对眶内结构损伤轻，术后义眼片活动性更佳。     

改良巩膜壳内羟基磷灰石义眼台植入术的临床观察

目的：评价改良巩膜壳内羟基磷灰石义眼台植入术的临床效果。
　　方法：对34例患者施行眼内容物剜除后,自体巩膜壳前后均瓣状成形并后巩膜开窗,一期植入羟基磷灰石义眼台,术后观察结膜伤口愈合情况、义眼台活动度及并发症的出现情况。
　　结果：随访观察6~12mo,未发现义眼台暴露、巩膜溶解、结膜伤口裂开、结膜囊缩窄病例。安装义眼片后,活动度良好,眼球内外侧转动可达10o~15o,睑裂双侧等大,外观双眼基本对称,眼窝饱满。
　　结论：改良巩膜壳内羟基磷灰石义眼台植入术基本保持了眶内组织的正常解剖关系,术后眼窝饱满度、义眼台活动度良好,手术操作简单易行。通过观察随访,并发症少,临床效果满意。     

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。     

改良羟基磷灰石义眼台一期植入防治植入物暴露的临床观察

目的 探讨羟基磷灰石义眼台（HA）一期植入的方法,如何减少植入物暴露的临床措施.方法 应用自体巩膜花瓣状成形、眼球内视神经剪断的方法包裹HA一期植入.结果 本组26例HA一期植入术后均达到良好效果.随访4～23月无义眼台脱出或移位现象,也未出现异常眼眶炎症反应.结论 本术式临床疗效良好,并发症少,术后义眼座活动度好.     

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台植入术临床观察

目的:观察改良的羟基磷灰石义眼台植入术的疗效。方法:对32例改良的义眼台植入术,其中Ⅰ期18例,Ⅱ期14例,进行回顾性分析。结果:本组改良的羟基磷灰石义眼台植入术后,义眼活动度好,与健眼同步,无脱出、眼窝凹陷或上睑下垂;其中3例义眼台暴露,重新手术修补。结论:对严重的眼球破裂伤、无光感疼痛性眼球或萎缩眼球患者行改良的羟基磷灰石义眼台植入术,是一种较安全而有效的方法。     

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。     

眼内容剜除联合多孔羟基磷灰石义眼座植入术临床分析

目的：评价眼内容剜除术联合羟基磷灰石（Hydroxyapatite HA)义眼座植入术的疗效和安全性。方法：1998．1－2000．5在本中心接受眼内容剜除联合HA植入术的78例病例进行回顾性分析。收集各病例临床资料、手术指征、义眼座的大小、手术疗效和术后并发症。平均随诊时间11．6月（2－24月）。结果：本组共78例患者接受眼内容剜除联合HA植入术,全部病例均获得手术成功。术后无一例患者出现义眼座外露、脱出、移位等并发症。随诊期间无交感性眼炎发生。结论：在严格选择手术适应症的条件下,眼内容剜除术联合HA后置植入术是一种安全而有效的治疗部份无光感疼痛性眼球或萎缩眼球的方法。     

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。     

眼眶爆裂性骨折眼球内陷的晚期整复治疗

目的 研究眼眶爆裂性骨折眼球内陷晚期手术的方法及疗效,评估羟基磷灰石复合人工骨眶内植入的安全性及有效性。方法 应用眼眶三维测量方法及复视分析方法,以自体骨及羟基磷灰石复合人工骨作为填充材料,对21例眼眶爆裂性骨折眼球内陷患者施行晚期眼眶修复眼球复位术,并进行比较研究。结果 18例患者的眼球内陷被矫正,3例治疗无效。16例复视患者中,8例患者复视情况有所改善,8例治疗无效。自体骨及复合人工骨眶内植入的疗效无显著差异。结论 眼眶爆裂性骨折眼球内陷的晚期重建复位手术可获得满意疗效。羟基磷灰石复合人工骨眶内植入是安全及有效的。     

HA眼台植入后脓性肉芽肿形成的原因分析

目的分析珊瑚多孔羟基磷灰石(HA)义眼台眶内植入术后脓性肉芽肿形成的原因,探讨其有效的治疗方法。方法回顾性分析我院眶内植入HA义眼台250例(钻孔及栓钉置入68例),外院1例,随诊18月-10年,脓性肉芽肿形成后给予药物及手术治疗。结果250例中发生脓性肉芽肿6例,其中5例在钻孔及栓钉置入术4～7年后发生,1例发生时羟基磷灰石义眼台未钻孔。6例保守治疗效果欠佳,均行HA义眼台取出术。结论脓性肉芽肿的发生原因可能与义眼台血管纤维化不足,义眼台暴露,异体巩膜包被,义眼台钻孔及栓钉置入等有关。脓性肉芽肿保守治疗效果欠佳,最终行义眼台取出术。     

The use of vicryl mesh in 200 porous orbital implants: a technique with few exposures

PURPOSE: To report the results of a wrapping technique for porous orbital implants by using polyglactin 910 (Vicryl) mesh (Ethicon Inc., Somerville, NJ, U.S.A.). METHODS: We retrospectively reviewed the records of 200 consecutive patients from one author's practice who received a polyglactin 910 mesh-wrapped porous orbital implant after enucleation or as a secondary implant between October 1, 1996, and April 15, 2001. We recorded potential problems that might be attributed to polyglactin 910 mesh both before pegging (excessive inflammatory response to the material, conjunctival thinning, and implant exposure) and after pegging (exposure of the implant around the sleeve, conjunctival thinning, and implant exposure other than adjacent to the peg). RESULTS: One hundred twenty-two men and 78 women underwent placement of a polyglactin 910 mesh-wrapped porous orbital implant. The average age at the time of implantation was 48.9 years (range, 11 to 85 years). The average follow-up interval in the 200 patients was 19.4 months (range, 2 to 80 months). Thirteen of the 200 patients had less than 6 months of follow-up, leaving 187 patients with an average follow-up of 20.5 months (range, 6 to 80 months). There were 76 primary enucleations and 124 secondary orbital implants. Thirty-seven patients received a Bio-Eye hydroxyapatite implant (HA) (Integrated Orbital Implants, San Diego, Calif), 97 received a synthetic FCI hydroxyapatite implant (FCI, Issy-Les-Moulineaux, France), and 66 received a Bioceramic implant (aluminum oxide-Al2O3) (FCI, Issy-Les-Moulineaux, France). One hundred fourteen patients (57%) underwent peg placement. The average time to pegging was 9.9 months (range, 6 to 16 months). Before pegging, 4 of 187 patients (2.1%) had implant exposure. Three of these exposures followed secondary orbital implant placement (2 Bio-Eye HA, 1 synthetic FCI3 HA) and one followed an enucleation (synthetic FCI3 HA). Two patients required a temporalis fascia graft and one required a scleral patch; the remaining defect closed spontaneously. One patient had conjunctival thinning 6 months after orbital implantation, which remained stable with no frank exposure for 36 months. No patient had excess socket inflammation. After peg placement, 3 additional patients had exposure of the implant around the peg site. There were no cases of conjunctival thinning or exposure of the implant other than adjacent to the peg site. CONCLUSIONS: Polyglactin 910 mesh is an excellent option as a wrapping material for porous orbital implants. It is simple to use, readily available, eliminates the need for donor tissue, does not require a second operative site, and it is less expensive than other currently available wrapping materials. We attribute our high success rate to our technique, which emphasizes proper placement of the implant within the Tenon space, suturing the extraocular muscles anterior to their normal anatomic sites, and meticulous closure of the Tenon capsule and conjunctiva in separate layers.     

羟基磷灰石义眼台眶内植入术后结膜脓性肉芽肿形成的原因分析(英文)

目的:分析羟基磷灰石(hydroxyapatite,HA)义眼台眶内植入术后结膜脓性肉芽肿形成的原因。方法:回顾性分析我院眶内植入HA义眼台250例(钻孔及栓钉置入68例),随诊18mo~10a,脓性肉芽肿形成后首先药物保守治疗,无效后采用手术治疗。结果:植入HA义眼台250例中发生脓性肉芽肿10例,其中9例在钻孔及栓钉置入术4~7a后发生,1例发生时羟基磷灰石义眼台未钻孔。9例保守治疗效果均欠佳,行HA义眼台取出术,1例拒绝眼台取出而继续保守治疗。结论:脓性肉芽肿是严重的义眼台植入术后并发症,发生原因可能与义眼台植入后血管化不足,义眼台暴露与继发感染,异体材料包被,义眼台钻孔及栓钉置入等因素有关,而与栓钉的材料无关。脓性肉芽肿的发生意味着义眼台可能发生了感染,最终需行义眼台取出术。     

Hydroxyapatite orbital implant vascularization assessed by magnetic resonance imaging

PURPOSE: To report hydroxyapatite (HA) implant enhancement patterns on magnetic resonance (MR) images at varying time intervals after implantation. METHODS: We retrospectively reviewed the records of 45 consecutive patients(from one author's practice) who underwent an MR imaging study 2 to 157 months after HA orbital implant placement. Implant fibrovascular ingrowth was assessed by analyzing the extent of implant enhancement seen on MR imaging.RESULTS Of 21 patients undergoing gadolinium-DTPA T1-weighted MR imaging 2 to 7 weeks after HA placement, 15 had enhancement limited to the implant rim (Grade I or less). Five patients had peripheral foci of enhancement (Grade II), and one patient had foci of enhancement extending to the center of the implant (Grade III). MR images obtained 9 to 15 weeks after HA insertion in all 14 patients had some degree of central enhancement (Grade III) and 11 had homogeneous enhancement throughout the implant (Grade IV or V). Seven patients in the homogeneous group were believed to have particularly intense enhancement patterns (Grade V). Of the 10 patients undergoing MR imaging from 31 to 69 weeks after surgery, 5 had Grade III enhancement and 5 had Grade IV enhancement. CONCLUSIONS: This study demonstrated consistent central HA orbital implant enhancement on MR imaging in the 9- to 15-week group and the >31-week postoperative group. HA orbital implant drilling and peg placement should be performed after central vascularization of the spherical implant has occurred. The results of this study support the principle of performing orbital implant drilling and peg placement at least 5 to 6 months after HA implant insertion.     

羟基磷灰石义眼座血管化的MRI量化数据分析

目的:在以往研究的基础上,运用MRI量化数椐分析帽式巩膜瓣覆盖法植入羟基磷灰石（HA）义眼座血管化情况,评价该术式的优越性。方法:回顾性分析26例眼眶内植入HA义眼座MRI表现,术后1~10mo至少行一次MRI平扫及增强检查,计算出义眼座的VE/VHA比值,VE为义眼座强化区体积,VHA为义眼座体积。结果:患者26例眼眶内植入HA义眼座均未出现手术并发症。收集到VE/VHA比值分布为术后1mo 3例,术后2mo 5例,术后3mo 5例,术后4mo 7例,术后5~10mo 6例,经统计学处理后显示前5mo HA内血管变化明显,5mo 后则不再发生变化。结论:MRI增强扫描可以精确量化观测义眼座血管化程度和范围,帽式巩膜瓣覆盖法植入HA义眼座完全血管化的时间是术后5mo左右。