脱细胞异体真皮的不同朝向对其覆盖义眼台手术疗效的影响

Effect of different orientation of acellular dermal allografts as covering material on hydroxyapatite orbital implantation

目的探讨在羟基磷灰石义眼台植入术中,脱细胞异体真皮覆盖义眼台及其两个不同组织面的朝向对手术效果的影响。设计病例对照研究。研究对象北京同仁医眼科中心接受羟基磷灰石义眼台植入术,且术中采用脱细胞异体真皮覆盖义眼台的患者20例(20眼)。方法患者随机分为2组,第一组(基底朝外组)10例患者,在覆盖义眼台时,植入脱细胞异体真皮的基底膜面朝外;第二组(真皮朝外组)10例患者,植入异体真皮的真皮面朝外。所有患者均随访24周,观察比较两组间结膜伤口、结膜下组织愈合以及结膜囊的情况。主要指标结膜伤口愈合状况、结膜水肿消退时间、结膜囊有无明显皱缩以及结膜下植片情况。结果基底朝外组和真皮朝外组两组患者术后结膜伤口均愈合良好,结膜水肿消退时间分别为(13.1±1.79)天和(12.8±1.93)天(t=0.355,P>0.05);结膜囊均未见明显缩窄;结膜下植片呈白色致密状。两组患者均未出现术后并发症(包括感染、血肿、切口不愈合、异体真皮坏死、义眼台暴露等)、未发生二次手术(包括清创手术、修复手术、取出术等)。两组患者均于术后4周佩戴义眼片,效果满意。结论脱细胞异体真皮在义眼台植入术中是良好的屏障及覆盖材料,且不需要区分两个不同组织面的朝向,操作简单。

Objective To investigate the effect of acellular dermal allografts with different orientation as covering material in hydroxyapatite orbital implantation.Design Case control study.Participants Twenty patients(20 eyes)with acellular dermal allografts covering hydroxyapatite orbital implantation in Beijing Tongren Eye Center.Methods The patients were randomly divided into two groups.In the first group(basement outside group),10 patients were implanted with acellular dermal matrix with the basement membrane facing outward when covering the hydroxyapatite orbital implantation;in the second group of 10 patients(derma outside group),the derma surface outward.All patients were followed up for 24 weeks.The clinical evaluation of outcome and complications were compared between the two groups.Main Outcome Measures Clinical evaluation of outcome and complications,including regression time of conjunctival edema,healing of conjunctival wound,shrinkage or not of conjunctival sac and subconjunctival graft of acellular dermal allograft.Results The grafts were well tolerated,with no cases of infection or explanation in the two groups.The regression time of conjunctival edema was 13.1±1.79 days and 12.8±1.93 days in the basement outside group and derma outside group,respectively(t=0.355,P>0.05).There was no obvious narrowing of conjunctival sac found;and all subconjunctival grafts showed white and dense in the two groups.The conjunctival wound healed well,without postoperative complications(including infection,hematoma,incision nonunion,acellular dermal allografts necrosis,orbital implantation exposure,etc.),and no secondary surgery(including debridement,repair and removal)in the two groups.Patients of the two groups were all prothesis 4 weeks after the operation,and the effect was satisfactory.Conclusion Acellular human dermis is an excellent barrier and covering grafting material in hydroxyapatite orbital implantation,and possesses excellent handling properties without needing to distinguish the orientation.