中国修复重建外科杂志

中国修复重建外科杂志

带软骨膜的薄层肋软骨作大翼软骨外侧脚支撑移植物在唇裂继发鼻畸形中的应用

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目的 探讨带软骨膜的薄层肋软骨作大翼软骨外侧脚支撑移植物在唇裂继发鼻畸形矫正术中的应用及临床效果。 方法 2015 年 10 月—2017 年 4 月,收治 28 例唇裂继发鼻畸形患者。男 16 例,女 12 例;年龄 18~31 岁,平均 24 岁。继发鼻畸形左侧 11 例、右侧 13 例,双侧 4 例。采用鼻唇肌肉三维定向立体术重建修复术矫正畸形,术中取自体肋软骨行鼻小柱、鼻背支撑,同时以带软骨膜的薄层肋软骨作大翼软骨支撑。术前及术后 6~8 个月摄鼻底位照片,以鼻小柱与上唇交界中点为 O 点,通过 O 点的横向水平线记为 X 线、纵向线(即面中线)记为 Y 线。测量手术前后患侧鼻孔最高点至 X 线距离、患侧鼻孔最外侧点至 Y 线距离,双侧鼻孔最高点对称性、鼻孔最外侧点对称性;所有患者鼻尖最高点至 X 线距离。 结果 术后切口均Ⅰ期愈合。患者均获随访,随访时间 6~24 个月,平均 12 个月。患者鼻翼大小、形态稳定,无软骨外露、血肿、感染等发生。术后 4 例切口瘢痕明显、3 例鼻孔及鼻翼不对称,1 例患侧鼻翼外侧脚位置欠佳。单侧畸形患者双侧鼻孔最高点对称性术前为 57.643%±27.491%、术后为 90.246%±18.769%;鼻孔最外侧点对称性术前为 77.391%±30.628%、术后为 92.373%±21.662%;手术前后比较差异均有统计学意义(P<0.05)。患侧鼻孔最高点至 X 线距离、鼻孔最外侧点至 Y 线距离、鼻尖最高点至 X 线距离手术前后比较差异均有统计学意义(P<0.05)。肋软骨供区无胸廓外形改变。 结论 带软骨膜的薄层肋软骨支撑力好、长期效果稳定,可作为唇裂继发鼻畸形中鼻翼软骨移植的理想材料之一。

Objective To explore the application and effectiveness of thin-ribbed cartilage with the perichondrium in the correction of secondary cleft lip nasal deformity as the lateral crural onlay graft. Methods A retrospective study was performed based on the data of 28 patients with secondary nasal deformity of cleft lip between October 2015 and April 2017. There were 16 males and 12 females with an average age of 24 years (range, 18-31 years). There were 11 cases with secondary nasal deformities on the left side, 13 cases on the right side, and 4 cases on both sides. Three-dimensional stereotaxy of the nasolabial muscles was used to correct the deformity. The costal cartilage as the support was used to perform nasal columella and nasal dorsum while the thin-ribbed cartilage with the perichondrium was used as wing cartilage support. The photography of nasal position was taken before operation and at 6-8 months after operation. The midpoint of the junction between the nasal columella and the upper lip was marked point O; the lateral horizontal line passing through the point O was marked as X-line, and the longitudinal line (the midline) as Y-line. The distance of the highest point of the affected nostril to the X-line, the distance of the nostril’s outermost point to the Y-line, the symmetries of both the most lateral and the highest point of the bilateral nostrils, and the distance of the highest point of the nasal tip to the X-line were measured. Results All incisions healed by first intention. All patients were followed up 6 to 24 months with an average of 12 months. The size and shape of the noses were stable, and no complication, such as cartilage exposure, hematoma, or infection occurred during the postoperative follow-up. There were 4 cases with obvious incision scars, 3 cases with nostril and alar asymmetry, and 1 case of lateral side of the nose without well positioned. The symmetry of the highest point of bilateral nostrils was 57.643%±27.491% before operation and 90.246%±18.769% after operation. The symmetry of the most lateral point of the bilateral nostrils was 77.391%±30.628% before operation and 92.373%±21.662% after operation. And there were significant differences between pre- and post-operation (P<0.05). There were also significant differences in the distance of highest point of the affected nostril to the X-line, the distance of the nostril’s outermost point to the Y-line, and the distance of the highest point of the nasal tip to the X-line (P<0.05). No thoracic contour change occurred at the costal cartilage donor site. Conclusion The thin-ribbed cartilage with the perichondrium has good support and long-term stability, and it can be used as one of the ideal materials for nasal alar cartilage transplantation for nasal deformity secondary to cleft lip.

关键词: 唇裂继发鼻畸形; 肋软骨; 软骨膜; 大翼软骨; 大翼软骨外侧脚支撑移植物

Key words: Cleft lip secondary nasal deformity; costal cartilage; perichondrium; alar cartilages; lateral crural onlay graft

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