改良自体巩膜帽状扣盖术在羟基磷灰石义眼台植入术中的应用

The application of the improved method of autologous sclera cap-shaped cover in hydroxyapatite implantation

目的观察改良自体巩膜扣盖术对自体巩膜较小者行羟基磷灰石（HA）义眼台植入术的临床效果。方法对10例（10眼）眼球萎缩和6例（6眼）眼内容摘除术后有自体巩膜但仅能包裹义眼台1／4～1／2者，将自体巩膜呈帽状包盖固定于义眼台前极后植入肌锥内，再与肌肉止端缝合。结果本组16例中有14例结膜创口一期愈合，2例结膜切口裂开经保守治疗2周后自愈。术后随访3月～3年，无发生感染、义眼台暴露及交感性眼炎等并发症者。所有患者义眼活动良好，美容效果理想。结论改良HA义眼台植入术安全可靠，适用于自体巩膜较小者。

Objective To observe the clinical effects of the improved method of autologous sclera capshaped cover in hydroxyapatite implantation, applying to these patients whose sutolo- gous sclera was not large enough to wrap hydroxyapatite implants. Methods 10 cases （ 10 eyes） with atrophy of eyeballs and 6 eases （6 eyes） after enucleating the contents of eyeball whose autologous sclera only wrapped the 1/4 to 1/2 hydroxyapatite sphere. Before the hydroxyapatite sphere was implanted into muscular pyramid, the frontal part of which was cap-shaped covered and fixed by autologous sclera,and then sutured the end of ophthalmic muscles. Resuits In the 16 cases, 2 cases conjunctiva split appeared and healed itself 2 weeks later, all the other 14 cases conjunctiva were primary healing. In three months to 3 years following up period, there was no complicatios, such as infection, hydroxyapatite implants exposure or sympathetic ophthalmia. The effects of pseudo- ophthalmic mobility and the cosmetic appearance were satisfactory. Conclusions The improved method in hydroxyapatite orbital implantation is safe and reliable. It can be applied to the patients whose autologous sclera was not large enough to wrap hydroxyapatite sphere.