两种不同移植方式行I期羟基磷灰石义眼座假体置入的比较

摘要

BACKGROUND: There are two commonly used techniques of primary orbital implant placement, one is using sclera to cover hydroxyapatite prosthesis after evisceration and the other is using sclera to wrap around the hydroxyapatite prosthesisafter enucleation, which one is more efficient and safer.OB.IECTIVE: To compare the clinical safety of the two kinds of surgery for placing hydroxyapatite prosthesis in the orbit.DESIGN, TIME AND SETTING: A retrospective case analysis was performed.between June 2000 and June 2005 at Xiangya Hospital, Central South University, Changsha, Hunan Province, ChinaPARTICIPANTS: Fifty eyes of 50 cases who were admitted between June 2000 and March 2003 to accept enucleation implants, including 39 cases with atrophic eyeball, 6 cases with anterior scleral staphyloma, 1 case with absolute glaucoma, 4cases with eyeball rupture. Forty-nine eyes of 49 cases who were admitted between April 2003 and June 2005 to accept evisceration implants, including 36 cases with atrophic eyeball, 8 cases with anterior scleral staphyloma, I case with absolute glaucoma, 4 cases with eyeball rupture. All the operations performed by the same surgeon.METHODS: In enucleation implant group, autologous sclera-wrapped hydroxyapatite orbital implant was placed into the muscle cone after enucleation. In evisceration implant group, the bared hydroxyapatite orbital implant was placed into muscle cone after evisceration, and was covered by autologous sclera in anterior.MAIN OUTCOME MEASURES: Appearance improvements and complications of patients after orbital implant placement. RESULTS: There was no significant difference between the two groups in appearance improvement. In enucleation implant group, 7 patients experienced conjunctival dehiscence and 5 patients experienced orbital implant exposure. In evisceration implant group, no conjunctival dehiscence and orbital implant exposure occurred. There were significant differences between the two groups in conjunctival dehiscence ( x2 =7.380, P < 0.01) and orbital implant exposure( x2 =5.160, P < 0.01 ).CONCLUSION: Evisceration with sclera-covered orbital implant is more simple, safe, convenient and effective than enucleation with sclera-wrapped orbital implant.%背景:临床上较常采用的I期义眼座假体置入方式有眼球摘除巩膜包裹法和眼内容剜除巩膜盖法.哪种义眼座移植方式的疗效和安全性更好?目的:比较两种不同移植方式行I期羟基磷灰石义眼座置入后的安全性.设计、时间及地点:回顾性病例分析,组间均衡设计.2000-06/2005-06在中南大学湘雅医院完成.对象:于2000-06/2003-03入院行眼球摘除巩膜包裹法置入义眼座者50例50眼,眼球萎缩39眼,角巩膜葡萄肿6眼,绝对期青光眼1眼,眼球破裂伤4眼.于2003-04/2005-06入院行眼内容剜除巩膜覆盖法置入义眼座者49例49眼,眼球萎缩36眼,角巩膜葡萄肿8眼,绝对期青光眼1眼,眼球破裂伤4眼.所有手术均由同一术者完成.方法:眼球摘除巩膜包裹法置入义眼座组采用的是眼球摘除后以自体巩膜包裹义眼座,再将其置入肌圆锥内.眼内容剜除巩膜覆盖法置入义眼座组采用的是眼内容剜除术后将全裸的义眼座置入肌圆锥,再将自体巩膜覆盖义眼座前极.主要观察指标:两组患者配戴义眼后外观改善程度及并发症.结果:两组患者外观改善程度差异无显著性意义.眼球摘除巩膜包裹法置入义眼座组有7例结膜伤口裂开,其中5例义眼座暴露.眼内容剜除巩膜覆盖法置入眼座组无结膜伤口裂开发生率差别有显著性意义(x2=7.380,P<0.01),义眼座暴露发生率差别也有显著性意义(x2=5.160,P<0.01).结论:眼内容剜除巩膜覆盖法是一种较眼球摘除巩膜包裹法简单、安全、方便、疗效确切的义眼座假体置入方式.