作者：张虹，李贵刚，胡军
作者单位：（430030）中国湖北省武汉市，华中科技大学同济医学院附属同济医院眼科
【摘要】目的：观察异形羟基磷灰石义眼台植入术并发症及手术效果，探讨异形义眼台的适应证及其临床应用价值。
方法：设计不同体积的异形羟基磷灰石义眼台，治疗眼球萎缩、眼内容物摘除及眼球摘除术后患者共30例。对照组植入常规圆球形羟基磷灰石义眼台共30例。异形义眼台组与对照组间性别、年龄、眼部情况相似。手术后随访时间6mo以上，观察患者义眼台植入术后球结膜愈合时间、义眼台暴露、感染等并发症、义眼台活动度、位置以及与义眼片适合程度的差异。
结果：异形羟基磷灰石义眼台组没有发生义眼台暴露、感染等严重并发症，球结膜愈合时间短，义眼台植入后前表面呈圆弧形，能与义眼片很好的吻合，义眼台活动度及位置均好于对照组。对照组有2例（7%）发生早期球结膜裂开的并发症，经过治疗后均愈合。
结论：异形义眼台可以降低义眼台植入后引起的并发症，可以有效适应患者眼部病变的情况，获得良好的手术效果，适应证更广，安全性更好。
【关键词】 羟基磷灰石义眼台；异形；手术；并发症
Study of the outcome of obform hydroxyapatite orbital implant surgery
Hong Zhang, GuiGang Li, Jun Hu
Department of Ophthalmology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
Correspondence to: GuiGang Li. Department of Ophthalmology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China. [email protected]
AbstractAIM: To observe the outcome of obform hydroxyapatite orbital implant surgery, and to investigate the indication of this surgery and its clinical application. METHODS: Sixty patients (60 eyes) who had atrophia bulbi, evisceration or ophthalmectomy received hydroxyapatite orbital implant surgery for atrophia bulbi in this study. They were randomly divided into 2 groups: study group and control groups (30 eyes in each group). Various kinds of obform hydroxyapatite orbital implants were designed for the patients in the study group. Other 30 patients in the control group had round hydroxyapatite orbital implant implanted into orbital. The age, sex and disease of the patients in 2 groups were almost same. All patients were observed over 6 months, the postoperative complications, the motion range and position of the implants and the fitness to prosthesis were compared between two groups. RESULTS: There were no postoperative complications after obform hydroxyapatite orbital implant surgery. The motion range and position of the obform hydroxyapatite orbital implants in polyporate sclera shell were better than that of the control group's. The obform hydroxyapatite orbital implant could fit to the prosthesis nicely. There were 2 patients (7%) in the control group developed break in conjunctiva, which healed after medicine or surgery treatment. CONCLUSION: The obform hydroxyapatite orbital implant can reduce the postoperative complications, it can be used to utilize the autogeneic sclera and works for better outcome of the surgery.
KEYWORDS: hydroxyapatite orbital implant; obform; surgery; complication
0引言
羟基磷灰石（hydroxyapatite,HA）义眼台作为眼眶内充填物已被广泛用于临床。评价一个义眼台植入手术效果的标志是其并发症的多少和仿真性的优劣。理想的义眼台植入眼眶后应该充分发挥填充功能，矫正眼窝凹陷畸形；应该能够与其前方的义眼片完美吻合，从而能够灵活转动；最重要的是义眼台植入术后不能发生义眼台暴露、感染等并发症。手术者为了减少并发症的发生，往往倾向于将义眼台植入眼眶深部，多采用眼球摘除后植入肌锥内。这些手术方式固然减少了义眼台暴露的发生机会，却因为肌肉、血管、眶脂肪的损伤而导致义眼台活动度和眼窝凹陷矫正效果。已经证明，将义眼台植入到眼球原在位置的手术方式可以获得最佳的眼球活动度和效果。然而在眼球萎缩较重或者已经实施了眼内容物摘除手术后二期植入义眼台的病例，即使采用了镂空巩膜的方法仍然无法把常规圆形义眼台植入巩膜壳内，也有些患者本身合并眶内空间的狭窄，勉强植入常规的圆形义眼台，因为结膜伤口张力过大而发生义眼太暴露的危险增加[13]。义眼台植入术最主要的并发症是义眼台暴露、感染，其发生机制被认为是义眼台血管化不良或延迟[46]。因此我们研制了可以植入巩膜壳内的异形义眼台。本文报道了24例镂空巩膜内植入异形义眼台的手术效果，现报道如下。
1对象和方法
1.1对象
所有患者均为200501/200701在我院眼科住院病例。患者眼病包括：眼球萎缩、眼内容物摘除术后、眼球摘除术后。根据患者年龄、性别和眼部情况随机分为两组：异形羟基磷灰石义眼台组和圆形义眼台组。异形羟基磷灰石义眼台组30例，患者年龄12~54（平均32.4）岁，男22例，女8例。圆形义眼台组30例，患者年龄10~56（平均34.7）岁，男23例，女7例。羟基磷灰石义眼台购于北京康菲特尔公司，圆形义眼台直径18~22mm，孔径500μm；异形义眼台前面为球形，后面为锥形，整体体积小，孔径500μm（图1）。
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