9 圆锥形义眼台[18]
圆锥形义眼,前端为半径18.0mm,弦长18.0mm的球面,弧长18.84mm,中心高度18.0mm,视神经端半径9.0mm, 弦长9.0mm 的球面, 弧长9.42mm,前端与视神经端之间的边线约14.5mm,周长约57.26mm,稍小于筋膜囊弧长,常规眼球摘除,义眼座植入肌圆锥内,眼外肌的直肌瓣一并对称缝合,固定在义眼台前部的心脏涤纶补片,缝合筋膜囊及结膜。本式利用了心脏涤纶补片的涤纶纤维之间存在微孔,使结缔组织和毛细血管侵入,可充分血管化,义眼有一定的活动度,手术方法操作简单,且圆锥形义眼符合肌圆锥内形状,减少了植入物脱出的几率。
10 注入式义眼台[19]
角巩膜缘外4mm做巩膜切口3mm,预置褥式缝线,去除眼内容物后,注入按粉液比20g∶10mL比例混合的骨水泥,关闭巩膜切口,缝合结膜瓣,术后3mo后呈现为眼角膜血管化,围绕义眼台形成纤维膜,炎性反应基本消失。注入式义眼台技术手术操作相对简单,经济易行,并且充分利用了眼球眼外肌的生理附着,术后义眼有良好的活动,逼真的外观,但目前处于动物实验阶段。
目前,义眼台植入方法很多,主要在细节上存在不同,术者常从两方面考虑:(1)防止义眼台的暴露;(2)提高义眼台的活动度,因此将义眼台植入肌椎内,位置宜深不宜浅,但义眼表面多粗糙,植入时周围组织易粘附在眼台表面,往往使位置偏浅,防范措施可借薄膜使眼台滑入肌椎深部,复位周围的结缔组织后再行无张力缝合筋膜和结膜[20]。我们相信,随着科学的发展,手术方法的不断改进,义眼将越来越接近人眼的生理状态。
【参考文献】
1 DouiraKhomsi W, Korchane N, Louati H, et al. MRI exploration for the evaluation of orbital implant biocolonization in children enucleated for retinoblastoma. J Fr Ophtalmol 2009;32(8):540543
2 Norda AG, MeyerRusenberg HW. Experience with orbital implants in particular with porous hydroxyapatite materials. Ophthalmologe 2003;100(6):437444
3 Custer PL,Trinkaus KM. Porous implant exposure: incidence, management, and morbidity. Ophthal Plast Reconstr Surg 2007;23(1):17
4 Inkster CF, Ng SG, Leather B. Primary banked scleral path graft in the prevention of exposure of hydroxyapatile orbital implant. Ophthalmology 2002;109(2):389392
5 Perry AC. Integrated orbital implants. Adv Ophthalmic Plast Reconstr Surg 1990;8:7581
6 Tambe K, Pushpoth S, Mudhar HS, et al. A histopathologic study of orbital implant vascularization. Orbit 2009;28(1):5057
7 Suter AJ, Molteno AC, Bevin TH, et al. Long term follow up of bone derived hydroxyapatite orbital implants. Br J Ophthalmol 2002;86(11):12871292
8 Perrc JD, Tam RC. Safety of unwrapped spherical orbital implants. Ophthal Plast Reconstr Surg 2004;20(4):281284
9 You JR, Seo JH, Kim YH, et al. Six cases of bacterial infection in porous orbital implants. Jpn J Ophthalmol 2003;47(5):512518
10 潘恂,冯建国,何锦.巩膜花瓣状成形羟基磷灰石义眼座植入术疗效观察.眼外伤职业眼病杂志 2008;30(5);417418
11 王宁, 王太文,任红,等.巩膜转位羟基磷灰石义眼台植入术的应用.中国美容整形外科杂志 2008;19(5):393
12 刘文斌,孙思勤,温耀春,等.羊膜包裹的羟基磷灰石义眼台植入.眼科新进展 2001;21(3):191192
13 Jordan DR, Klapper SR, Gilberg SM. The use of vicryl mesh in 200 porous orbital implants: a technique with few exposures. Ophthal Plast Reconstr Surg 2003;19(1):5361
14 Gupta M, Lyon F, Singh AD, et al. Bovine pericardium (Tutopatch) wrap for hydroxyapatite implants. Eye (Lond) 2007;21(4):476479
15 Jordan DR, Klapper SR. A new titanium peg system for hydroxyapatite orbital implants. Ophthal Plast Reconstr Surg 2000;16(5):380387
16 Custer PL, Kennedy RH, Woog JJ, et al. Orbital implants in enucleation surgery: a report by the American Academy of Ophthalmology. Ophthalmology 2003;110(10):20542061
17 刘继红,汤喜成.空壳形碳纤维义眼座的研制及临床应用.中国实用眼科杂志 2002;20(1):7677
18 张松,刘德成.一种防脱出易制作义眼台的研究与应用.眼外伤职业眼病杂志 2008;30(6): 497499
19 刘瑶,屠颖,丁传凤,等.注入式义眼座技术的初步报告.国际眼科杂志2007;7(4):906908
20 Sagoo MS, Rose GE. Mechanisms and treatment of extruding intraconal implants:socket aging and tissue restitution (the "Cactus Syndrome"). Arch Ophthalmol 2007;125(12):16161620 上一页 [1] [2] |