DEVELOPMENT OF PERCUTANEOUS DEVICES MADE OF SINTERED HYDROXYAPATITE FOR THE DISABLE ELDERLY

为改善以神经系统疾病为主的老年人不能自主进食或大小便失禁的日常生活能力，研制了一种由烧结羟基磷灰石皮钮和硅橡胶连接管组成的经皮装置，并对3例经鼻胃管进食的老年人进行了经皮肠瘘植入术。经瘘管成功喂养，但由于与上覆皮肤的适应不良，导致裸露的皮肤按钮凸缘，肠饲在3个月内中断。在两头幼猪的颈部植入经皮装置，将膀胱与皮肤下的硅橡胶管连接，用于囊性瘘管。分别于术后2个月和3个月因尿石形成导致导管堵塞而引流失败，研制了一种由微孔PVA中空纤维和PVC管组成的带皮扣的腹腔内留置导管，用于老年糖尿病患者胰岛素注射部位的日常留置。需要改进装置设计和开发抗膀胱中尿结石形成的新材料。为进一步提高老年失能者的生活质量，还需进行进一步的研究。

Percutaneous devices consisting sintered hydroxyapatite skin button and silastic connecting tubes were developed for improvement of daily activities of the disabled elderly mainly because of neurological diseases who cannot orally eat by themselves, or have urinal incontinence.Three patients having been fed through nasogastric tubing were operatively implanted with the percutaneous devices for enteric fistula. They all were successfully fed through the fistula but enteric feeding ended in interruption within 3 months because of the denuded skin button flange due to misadaptation to the overlying skinTwo young pigs were implanted in their neck with the percutaneous devices connecting the bladder with a silastic tube underlying the skin for cystic fistula. Urine drainage through the devices was failed in 2 and months later, respectively, because of occlusion of tube with urine stone formation.An intraperitoneal indwelling catheter consisting of blind-ended microporous PVA hollow fiber and PVC tubing and having the skin button was developed for daily injection site of insulin especially for the aged diabetics.In conclusion, improvement of the device design and development of new material resistant to urine stone formation in the bladder are necessary. Further research has to be carried out for better QOL of the disabled elderly.