骨性巩膜钉封闭玻璃体切除术后巩膜创口实验观察

Observation of the closure of vitrectomy sclera wound with osseous nail

目的探讨骨性巩膜钉用于封闭玻璃体切除术后巩膜创口的效果。方法将30只新西兰白兔分为实验组和对照组,每组15只。每组再根据观察时间(术后1、2、4周,3、6个月)分别分为5个亚组,每个亚组3只。玻璃体切除术后,实验组用骨钉封闭兔眼玻璃体巩膜创口,对照组用8-0可吸收缝线缝合,比较两组手术时间,肉眼观察两组兔的眼部表现,定期处死动物后取出术眼行常规病理检查。结果实验组平均手术时间为15.6min,对照组16.73min,差异有统计学意义(P<0.05)。术后1周时,两组出现程度大致相同的球结膜和浅层巩膜充血,角膜保持清亮;2周时,实验组球结膜和浅层巩膜充血较对照组轻;6个月时,实验组眼部无明显反应,而对照组仍可见局部充血。组织学显示:术后早期两组呈现程度大致相同的炎性坏死反应;而后实验组炎性反应较对照组减轻得快;6个月时,实验组炎性细胞浸润进一步减少,而对照组无明显改变。结论骨性巩膜钉制作简单、植入方便、组织相容性良好,用于封闭玻璃体切除术后巩膜创口具有良好前景。

Objective To investigate the application of osseous nail in the closure of vitrectomy sclera wound. Methods Thirty New Zealand albino rabbits were divided into two main groups whose vitrectomy sclera wound was closed either with osseous nail （experimental group） or with 8-0 absorbed suture （control group）. Each group was divided into five subgroups of three animals in each according to the observation period. The operation time was compared between the two groups and the ocular signs were also observed. All animals were sacrificed whose operated eyes were enucleated for pathological examination. Results The average operation time was 15.6 rain in the experimental group and 16.73 min in the control group. One week after the operation, bulbar conjunctiva and superfacial sclera congestion was similarly observed in the two groups whose cornea were all kept clear. Two weeks later, the experimental group got a less congestion compared to the control group. Six months after the operation, none tissue reaction was observed in the experimental group, while a local congestion still could be observed in the control group. The histopathologic examination showed that there were numerous tissue inflanunatory necrosis in the eyes at early stage after the operation. Six months later, the inflammatory cells in the experimental group were greatly reduced, while no obvious change was seen in the control group. Conclusions The osseous nails could be made easily and embedded conveniently, which had a very good histocompatibility. It might be widely applied in the closure of vitrectomy sclera wound.