较大范围义眼台暴露三层修补的临床观察

Three layers repairment for large exposure defects of hydroxyapatite orbital implant

目的评价一种新的三层修补技术治疗羟基磷灰石义眼台植入术后暴露的手术效果。方法收集2010年10月至2012年10月收治羟基磷灰石义眼台植入后4-20周较大范围暴露的患者7例（7眼），表面清理后，采用三层组织修补法（由内向外：异体巩膜层一筋膜层一自体结膜移植片或口腔黏膜移植片）进行义眼台暴露的手术治疗。所有患者术前、术后均进行裂隙灯检查及眼前节照相。除1眼因暴露区域过大行口腔黏膜移植结膜囊修补外，其余6眼均用取自健眼的自体结膜移植进行结膜囊修补。结果在平均13个月的随访后，观察到1例口唇黏膜移植患者愈合良好，无暴露。7例患者均未再出现义眼台暴露现象，无任何炎性肉芽肿出现。术前与术后患者的结膜囊分泌物、HA有无暴露、有无结膜炎性肉芽肿等，差异均有统计学意义（均为P〈0．001）。结论较大范围的羟基磷灰石义眼台暴露的治疗非常困难，新的三层组织修补技术是一种有效的治疗途径。

Objective To evaluate the surgical efficacy of a newly devised three layers repairing surgical technique for large exposure defects of hydroxyapatite orbital implant. Methods Seven patients （7 eyes） with wide range hydroxyapatite orbital implant exposures were treated from October 2010 to October 2012. Hydroxyapatite ex posures occurred from 4 weeks to 20 weeks after implantation. The exposed hydroxyap atite anterior surface was cleaned up and the defect was closed by three layers （ from inside to outside） ：allogeneic sclera, fascia, conjunctival autograft or oral mucous mem brane graft. Preoperative and postoperative slit-lamp microscope and anterior segment photography were evaluated. Socket reconstruction was done in six patients with con junctival graft and in one patient with oral mucous membrane graft. Results The pa- tient with oral mucous membrane graft maintained closure of the defects during a mean follow-up of 13 months. No hydroxyapatite exposure was observed among 7 patients, no inflammatory granuloma was appeared. Conclusion Treatment of hydroxyapatite ex posures, especially those with large defects, can be difficult, and optimal results can be obtained by this new three layers repairing surgical technique.