不同材料眶内植入物在眼窝重建中的应用

Application of various orbital implants in orbital reconstruction

背景:对眶内植入物的分类、性质及其在眼窝重建中的应用和并发症的处理进行归纳总结。方法:第一作者应用计算机检索PubMed数据库(http://www.ncbi.nlm.nih.gov/PubMed)及CNKI数据库(www.cnki.net/index.htm),在标题和摘要中以"眶内植入物,羟基磷灰石"或"orbitalimplant,hydroxyapatite"为检索词进行检索。选择文章内容与眶内植入物类型、材料学特点、生物相容性及其应用效果相关,同一领域文献则选择近期发表或发表在权威杂志文章。根据纳入标准共纳入20篇文献。结果:熟悉眶内植入物的分类、特性,以及宿主与眶内植入物之间的反应,对于眼球摘除或眼内容物剜除后修复材料的合理选择是十分必要的。多孔羟基磷灰石义眼台无毒,无致敏性,组织相容性好,其多孔结构便于新生血管及纤维组织的长入,是目前眼球摘除后眼窝重建的主要植入物。义眼台暴露是其植入后最常见及最严重的并发症。在义眼台上包裹上另外一层组织可以减少多孔羟基磷灰石义眼台粗糙外表面对周围软组织的机械刺激,减少暴露的机会。结论:近年来的研究发现,羟基磷灰石义眼台植入时应用自体双层巩膜帽状扣盖亦可显著降低义眼台暴露的发生率。眶内植入物将向着组织相容性好,血管化快,抗感染能力强,并发症少等方向发展。

BACKGROUND：To analyze and summarize the classification,properties,application and complication treatment of orbital implant in orbital reconstruction.METHDOS：A computer-based online search of PubMed database（http：//www.ncbi.nlm.nih.gov/PubMed） and CNKI（www.cnki.net/index.htm） was performed for related articles with the keywords ＂orbital implant,hydroxyapatite＂ in English and Chinese.Articles regarding classification,material properties,biocompatibility and application effect of orbital implant,published recently in authoritative journals in the same fields were included.Finally,a total of 20 articles were included.RESULTS：Understanding of classification,features,reaction with host of orbital implant is very important for appropriate selection of materials for enucleation of eyeball,eye content removal.Porous hydroxyapatite ocular prosthesis is atoxic,and histocompatible with no sensitization.Moreover,the porous structures allow ingrowth of new vessels and fibrous tissues.It has become an important implant for orbit reconstruction following enucleation of eyeball.Orbital implant exposure is a common and severe complication after implantation.The orbital implant coated with a layer of tissues can reduce the mechanical stimulation of the rough surface and decrease incidence of exposure.CONCLUSION：Recent studies have shown that autologous double-sclera shape cover can significantly reduce incidence of exposure following hydroxyapatite orbital implantation.The histocompatibility,vascularization,anti-infection and complication reduction of orbital implant should be improved.