羟基磷灰石眼座置入后暴露临床研究及处理.docVIP

羟基磷灰石眼座置入后暴露临床研究及处理[摘要]目的：探讨分析羟基磷灰石眼座（hydroxyapatite，HA）置入后暴露的原因及处理。方法：对18例羟基磷灰石眼座（HA）置入后暴露的患者，用不同的方法进行治疗和回顾性总结分析。结果：眼座暴露多发生在7～30天，暴露范围在1～15mm，其中3例自行愈合，15例进行手术治疗。结论：义眼座暴露为HA义眼座置入术后较为严重的并发症，根据暴露范围大小，可采用不同方法处理，暴露范围为中度（＞5mm）以上时，应尽早手术。 [关键词]义眼座；暴露；治疗 [中图分类号]R779.64 [文献标识码]A[文章编号]1008-6455（2011）09-1336-02 Clinical analysis and treatment of hydroxyapatite artificial eye pedestal exposure after orbit implantation LIN Jing,BAO Xin,ZHU Jing (Department of Ophthalmology,People’s Hospital of Wuxi,Wuxi 214023,Jiangsu,China) Abstract:ObjectiveTo analyze the causes and treatment of HA artificial eye pedestal exposure after implantation.MethodsEighteen cases of HA orbital implant exposure were studied. Different treatment methods were applied, and their results are reviewed and analyzed.ResultsOrbital implant exposures occurred typically 7 to 30 days after implantation. The diameters of the exposures ranged from 1 to 15mm.Three of the cases studied were treated conservatively, and the conjunctional dehiscence healed spontaneously,fifteen other cases were managed by operation.ConclusionThe exposure of HA artificial eye pedestal is a serious syndrome after implantation. Depending on the size of the exposure,several treatment methods may be applied. Medium- and large-sized exposure (5mm) should be operated as early as possible. Key words: orbital implant; exposure; therapy 义眼座置入使眼球摘除或眼内容物剜除术引起的上睑及上眶区凹陷后义眼的配戴更符合美学的要求。羟基磷灰石义眼座具有良好的生物相容性[1]，在眼窝重建中较其他填充材料显示出更多优点，已在临床广泛应用。但HA义眼座置入术后，义眼座暴露的并发症已引起临床医师的高度关注。我院于2005年至今行眼座置入术，对18例18眼羟基磷灰石眼座置入术后眼座暴露原因进行分析及处理。 1临床资料 眼座暴露共18例，其中男性14例，女4例，全部为单眼无光感眼，其中右眼6例，左眼12例，年龄在20～56岁，其中眼外伤17例，绝对期青光眼1例，均为Ⅰ期手术。暴露时间最早为7天，最晚30天。按照Remulla[2]对置入体暴露的分类方法分为：轻度（1～5mm）3例，中度（6～10mm）14例，重度（＞10mm）1例。眼部表现为结膜囊裂开、包裹组织溶解和义眼座暴露，裂口位置均在眼窝中央，如图1。 2材料和方法 2.1 用天然海珊瑚加工而成的内联多孔羟基磷灰石眼座，内联孔径为500mm左右。 2.2 眼座暴露的处理：①对所有眼座暴露的病例首先行抗感染治疗：轻度暴露（＜5mm)，采用刮除缺损区结膜边缘方法，使其露出新鲜结膜组织，待其自行修复；中度以上暴露者，待炎症控制后再行手术治疗；②结膜筋膜松解缝合术：术前结膜囊及暴露的眼座表面用抗生素充分冲洗，常规消毒，局麻，沿HA眼座表面充分分离结膜及