【作者】 滕铁波；

【导师】 陈晓隆；

【作者基本信息】 中国医科大学 ， 眼科学， 2004， 硕士

【摘要】 前言 羟基磷灰石(HA)义眼座作为理想的眶内植入物已被广泛接受和应用于矫正眼球摘出术或眼内容剜除术后出现的眼窝凹陷及继发畸形。国产HA义眼座临床应用效果良好。此手术优点及并发症均与HA义眼座的血管化过程密切相关。为使义眼座接近眼球在眼眶内的正常生理状态，多以自体巩膜或异体巩膜等材料将其包裹后植入眶内。由于眼球破损严重而行眼球摘除或眼球摘除后二期行HA义眼座眶内植入者，无自体巩膜，但需要大片自体或异体巩膜。为解决巩膜来源匮乏问题，本实验采用涤纶外科修补材料包裹HA义眼座行兔眼眶内植入，为新型包裹材料的临床应用奠定科学基础。 实验材料与方法 健康大耳白兔12只，按术后不同处死时间分为4组，每组3只；分别常规行眼球摘除术，然后用涤纶外科修补材料包裹直径为12mm的HA义眼座植入肌锥腔内。手术后1周内每天及手术后2、3、4、6、8、10、12、16、18周观察术眼局部反应、创口愈合状况；并分别于术后3周、6周、10周、18周各处死一组实验动物，将义眼座取出，剖开进行大体观察及组织学检查。 结果 所有兔结膜手术切口均愈合良好，未出现明显的并发症。所有植入物取出时发现其与周围眶组织粘连较为紧密，取出后涤纶材料紧密包裹于HA义眼座上，其外周有一层结缔组织包裹，部分区域有脂肪组织。3周时剖开植入物，发现其横断面上自周边已有新生纤维结缔组织长入义眼座内约2-3mm；6周时纤维结缔组织长入义眼座内4-5mm；10周时义眼座内基本充满纤维结缔组织；18周时义眼座内的纤维组织更加密集。植入物经脱钙处理留下相互联接的网状结构，而包裹的涤纶材料保持完好，与增生组织粘连紧密。HE染色显示随着义眼座植入时间的延长，长入义眼座孔隙内的纤维血管组织逐渐增多成熟。讨论 眼球摘出术或眼内容剑除术后出现明显的眼窝凹陷，并继发面部畸形，不利于义眼的安装及其活动度，影响了正常的美容效果。多年来，国内外学者们一直在寻求理想的眶内植人材料，曾有数十种生物和非生物类材料因不同程度的并发症而不适于临床应用。理想的眶植人物应具有良好的活动性和美容效果，且并发症较少。1985年Pe叮首先采用HA作为眶内植入物材料;经过十几年来国内外众多学者的实验研究和临床应用，HA已显示出其作为理想的眶植人物所应具有的优点。国产HA义眼座临床应用效果良好，被认为是目前较为安全有效的眶内植人物，此手术优点及并发症均与HA义眼座的血管化过程密切相关。HA义眼座与眼眶组织接触面积越大其完全血管化速率越快。最多见的并发症为植人物暴露，产生并发症的原因有多种。HA义眼座直接植人眶内时，由植人物粗糙表面引起的机械磨擦及经基磷灰石的化学性质可引起炎症反应，而使结膜和筋膜易于分解。据统计，包裹与不包裹义眼座植入眶内其暴露的发生率分别为7%和40%。为了预防植人物的暴露，多采用先将义眼座包裹再植人眶内的方法。包裹的材料主要是自体或异体巩膜等材料，由于眼球破损严重而行眼球摘除或眼球摘除后二期行HA义眼座眶内植人者，无自体巩膜，需要大片自体或异体巩膜，但它们来源有限。涤纶外科修补材料来源丰富，性能良好，与人体组织的相容性好;由于为人工材料，无因缺血而致坏死溶解的可能性。本实验采用涤纶外科修补材料包裹HA义眼座植人兔眼眶内，结果证实:涤纶外科修补材料与眼眶组织生物相容性好，包裹HA义眼座，对其血管化进程无影响，可以作为HA义眼座的包裹材料，且可以避免因使用异体材料而产生的风险。结论 用涤纶外科修补材料包裹HA义眼座行兔眼眶内植人的实验表明:涤纶外科修补材料与组织的相容性好，HA义眼座的血管化良好，未出现明显并发症，涤纶外科修补材料可以作为HA义眼座行眶内植人的包裹材料。更多还原

【Abstract】 IntroductionThe complications of enucleation and evisceration are socket and deformity. Hydroxyapatite (HA) orbital implants have be accepted and used extensively. The clinical effect of our national products coralline hydroxyapatite is well. The benefits and complications are related to vascularization course of the HA implants . To make the HA implants in normal physio - behavior and to decrease complications, it is wrapped with oneself or xenoma materials to implants. To obtain materials easily and decrease complications, the animal experiment of the HA implantation wrapped with the polyester surgical fabrics will provide the science base of clinical application of new materials.Materials and Methods, 12 rabbits were divided 4 groups and they had eye enucleated then received a 12mm HA sphere wrapped in polyester surgical fabrics. The conjunctiva! sac was examined everyday in one week and at 2, 3, 4, 6, 8, 10, 12, 16, 18 weeks postoperatively. One group were killed at 3, 6, 10, 18 weeks respectively after implantation , the implant was removed and cut open for observing and histopathological examinarion.ResultsAll the conjunctival wounds were healing well and no complication. All theHA implants adhere to the orbital tissue. The polyester surgical fabrics were tightly adherence to all the HA spheres and wrapped connective tissue and a few fat. At 3 weeks, to cut open the HA sphere showed the fibro ?vascular tissue ingrowth 2-3 mm from edge to center. At 6 weeks, the fibro - vascular tissueingrowth 4-5 mm. At 10 weeks, the HA sphere were full of fibro - vascular tissue. At 18 weeks, the fibro - vascular tissue in the HA sphere were intensive and firm. After decalcification, the HA sphere left reticularformation and the polyester surgical fabrics keep well and adherence to it tightly. HE stained, the section showed the fibro - vascular tissue invaded the interconnecting pores and the vascularization became intensive after implantation gradually.DiscussionEnucleation and evisceration will following socket and deformity. The mo-tility of the prosthesis will be limited which influence normal cosmetic result. For many years, the scholars have been searching ideal orbital implants. Many kinds of biological and no ?biological materials were not applicable as orbital implants for complication. Ideal orbital implants should have satisfactory motility and normal cosmetic result and few complication. In 1985, Perry had used the HA for the orbital implant first. After experimental research and clinical application , the HA had showed the benefits as an ideal orbital implant. Our national products HA with good clinical effect and are thought to be safe and effective orbital implants. The benefits and complications are related to vascularization course of the HA implants. The more the area of the HA contact to the orbital tissue, the fast of the rate of the the vascularization course of the HA implants. The most complication is the exposure of the implant. The causes of these complications are HAs mechanical and chemical stimulation to the conjunctiva. According to the statistics, the incidence of the implants exposure are 7% and 40% that they are wrapped or unwrapped respectively. To prevent the implants exposure, many people wrap it and then to implant. The wrapping materials are oneself sclera or xenoma materials. Both theirs source are limited. The polyester surgical fabrics have good compatibility and convenience to get and no possibilityof necrosis. The experiment of the HA implantation wrapped with the polyester surgical fabrics for animal, the result confirm that the polyester surgical fabrics have good compatibility to the orbital tissue and do not obstruct the course of vascularization of the HA implants. It is a good substitute for sclera and has no risk.ConclusionThe experiment suggested, the polyester surgical fabrics have good compatibility to the orbital tissue. The vascularization of the HA implants is well and has no complication . It can substitute for wrapping th更多还原