羟基磷灰石义眼座Ⅱ期植入术中寻找眼外肌的手术体会

The experience of secondary hydroxyapatite orbital implant surgeries

目的探讨羟基磷灰石(HA)义眼座Ⅱ期植入术中寻找眼外肌的方法,以减少并发症的发生。方法选择近5年来我科住院行HA义眼座Ⅱ期植入的其中73例(73只眼)患者,年龄5～74岁,男性多于女性,病因多样,以眼外伤最多见。手术方法:运用肌鞘-直肌法在内、外、上、下四个方位内寻找4直肌,选择相应大小的HA义眼座植入肌锥腔内,将4直肌固定于眼座表面,分层严密缝合筋膜组织、结膜。结果73例中有62例的四条眼外肌都可找到,其中包括视网膜母细胞瘤眼球摘除术后合并放疗的、眼座取出需再植入的、合并眶骨折的。其余11例中有3例视网膜母细胞瘤眼球摘除术后合并放疗的患眼找到3条直肌,2例眼座取出需再植入者找到2条直肌,5例严重眼外伤的找到3条直肌,仅1例患者只找到1条确切的直肌。植入后无1例发生眼座暴露,术后有5例发生上睑下垂,可能在寻找上直肌时损伤了提上睑肌所致,已通过手术予以矫正。结论循着肌鞘寻找眼外肌的方法不仅提高了手术成功率、减少了术后并发症的发生,而且防止了眼座的前移。此法适用于各种状况下的Ⅱ期眼座植入术。

Objective To introduce the method of finding the extraocular muscles toreduce complications in orbital implant surgeries. Methods Reveiw the clinical information of 73 patients who underwent secondary orbital implant sugeries in our hospital. Patients＇ age range from 5 years old to 74 years old. The number of male patients is more than female, the cause is various, most of which is ocular truma. Surgical MethodsWe use the sheath-rectus muscle method to find four rectus superiorly, inferiorly internally and externally. Select the appropriate size HA implant to place into intraocular cavity, fix the rectus muscles on the surface of the implant. Results In 62 out of 73 patients, four rectus muscles can be found during the surgery, including the post-operation retinoblastoma patients went through external beam radiation; patients who have implants need to be removed and change; patients with orbital fracture. In the rest 11 cases, three rectus muscles can be found in 3 patients of retinoblastoma after radiotherapy , two rectus muscles were found in 2 patients who need implant remove, three rectus muscles were found in 5 patients with severe ocular truma. Only in one case, there only one rectus muscle can be found. There is no conjunctiva exposure after surgery. Blephroptesis occurred in 5 cases after surgery, which may caused by the injuny of the levator muscle during the operation. The ptesis have been corrected by surgery. Conclusion Searching muscles .along the sheath not only improve the success rate of operation, reduce the complications, but also prevent the orbital implant protrusion. This method can be used in various kind of secondary orbital implant surgery.