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目的 探讨羟基磷灰石义眼座植入术后球结膜裂开的相关因素。方法 对57例患者的病例资料及术后2.5～45个月的随访情况进行总结分析。结果 术后55例外观效果满意;并发症主要有球结膜裂开(18例)、义眼座暴露(9例)及自体巩膜溶解(8例);球粘膜裂开18例中17例发生于术后4周内;球结膜裂开发生率与患者年龄、手术期别无关,与疾病种类、手术方法特别是有无自体巩膜包裹、手术熟练程度及HA义眼座品种有关;眼球萎缩和外伤后无眼球患者的发生率(7/31)较其他病种(11/26)低,眼球摘除自体巩膜包裹HA义眼座植入术16例中9例发生结膜裂开(8例伴自体巩膜溶解),眼球摘除后无包裹HA义眼座植入术36例中7例裂开。结论 眼外伤行修补术或眼球摘除术后患者二期义眼座植入的手术时间应适当推后;无包裹直接植入法的术后球结膜裂开发生率低于有包裹植入法,这一方法值得推广;自体巩膜离体后的处理方法尚需进一步探讨。
Objective To investigate the related factors of conjunctival rupture after hydroxyapatite orbital implantation. Methods 57 cases of patients and postoperative 2.5 to 45 months follow-up were analyzed. Results The appearance of postoperative 55 cases was satisfactory. The main complications were conjunctival rupture (18 cases), ocular prosthesis (9 cases) and autogenous scleral dissolution (8 cases). Spherical mucosal dehiscence in 18 cases occurred in 17 cases Within 4 weeks after surgery, the incidence of conjunctival rupture has nothing to do with the patient’s age and surgery, and is related to the type of disease, surgical methods, especially whether there is scleral entrapment, surgical proficiency and HA nocturnal atrophy; eye atrophy and trauma The incidence of non-ocular post-ocular (7/31) was lower than that of other diseases (11/26), and conjunctival dehiscence occurred in 9 of 16 (n = 8) Dissolved), no enucleated HA after enucleation, and 7 cases were split open in 36 cases. Conclusions The operation time of secondary orbital implantation after ocular trauma repair or enucleation should be appropriately delayed. The incidence of postoperative conjunctival rupture without parietal implantation is lower than that with parietal implantation, This method is worth promoting; autologous sclera after the treatment needs further study.