推顶式支架结构在肋软骨鼻综合整形术中的应用效果  

The application of"mutual support"framework in autologous costal cartilage rhinoplasty

作　　者：顾勤浩 李婧宇 王吉 冯啸[1] 孙燚[1] 严晟[1] 吴溯帆[1] 晋培红[1] Gu Qinhao;Li Jingyu;Wang Ji;Feng Xiao;Sun Yi;Yan Sheng;Wu Sufan;Jin Peihon(Department of Plastic&Reconstructive Surgery,Zhejiang Provincial People’s Hospital(Affiliated People’s Hospital,Hangzhou Medical College),Hangzhou 310014,China)

机构地区：[1]浙江省人民医院(杭州医学院附属人民医院)整形外科,杭州310014

出　　处：《中华整形外科杂志》2022年第7期730-736,共7页Chinese Journal of Plastic Surgery

基　　金：浙江省自然科学基金(LQ22H160020,LGF21H150004)。

摘　　要：目的探讨在肋软骨鼻综合整形手术中采用推顶式支架结构的临床效果。方法回顾性分析2020年6月至2021年12月浙江省人民医院整形外科收治的行自体肋软骨鼻综合整形术的患者临床资料。患者均采用双侧鼻下外侧软骨边缘切口联合鼻小柱切口,术中采取第6肋软骨雕刻成鼻小柱支撑移植物和鼻尖覆盖移植物一体化支架,以及鼻中隔延长移植物,将鼻小柱支撑移植物与鼻中隔延长移植物前后处于同一平面缝合、搭建推顶式支架,并置入鼻背假体,以纠正鼻部美学缺陷。采用Adobe Photoshop CS 6.0对患者术前和术后6个月面部像进行处理及测量,获取鼻额角、鼻尖角、鼻唇角、鼻小柱-小叶角、鼻尖突出度与鼻长度比、鼻尖下小叶与鼻小柱长度比等数值,对手术效果进行评价。术前和术后6个月采用视觉模拟量表(VAS)和鼻整形效果评价量表(ROE)对患者进行满意度调查。术前、术后鼻部指标测量值及量表评分比较采用配对t检验,P<0.05为差异有统计学意义。结果共纳入53例患者,男4例,女49例,年龄18~45岁,平均25.6岁。其中49例为初次鼻整形手术,4例为鼻修复手术。53例患者术后恢复顺利,住院期间未发生感染、出血等短期并发症。术后随访6~12个月,鼻额角、鼻尖角、鼻唇角、鼻小柱-小叶角、鼻尖突出度与鼻长度比值、鼻尖下小叶与鼻小柱长度比值与术前比较,差异均具有统计学意义(P<0.01),说明鼻部低平、鼻头肥大等美学缺陷均得以改善,鼻尖无明显偏曲、上旋或下旋。满意度调查结果:术后4~6周内肿胀基本消失,未发生明显通气障碍、感觉异常及嗅觉减退等症状;VAS和ROE量表术前评分分别为(6.1±0.5)分和(10.5±1.6)分,术后分别为(7.6±0.4)分和(21.3±2.1)分,明显高于术前(P<0.01),患者对鼻部美观及功能结果表示满意。结论采用推顶式支架结构进行肋软骨鼻综合整形手术,可减少远期软骨支Objective To investigate the clinical effect of"mutual support"framework in costal cartilage rhinoplasty.Methods From June 2020 to December 2021,the patients were enrolled and undergone rhinoplasty with bilateral lower lateral cartilage margin incision combined with nasal columnar incision in the Department of Plastic&Reconstructive Surgery of Zhejiang Provincial People’s Hospital.During the operation,the sixth costal cartilage was made into the nasal columella support graft(strut)and the nasal tip graft integrated scaffold,and the septal extension grafts(SEG).The strut and SEG were sutured in the same plane to construct the framework to correct the aesthetic defects of the nose.Abode Photoshop CS 6.0 was used to measure a series of aesthetics index before and 6 months after surgery,including nasofrontal angle,nasorostral angle,nasolabial angle,columella lobular angle,ratio of tip projection to the length of the nose and ratio of the length of the infratip lobule to the length of the nasal columella to evaluate the surgical effect.Visual analogue scale(VAS)and rhinoplasty outcome evaluation(ROE)were used to investigate the patients’satisfaction.Paired t-test was used for data analysis and P<0.05 was considered statistically significant.Results A total of 53 patients were enrolled,including 4 males and 49 females,aged from 18 to 45 years(average age:25.6 years).Forty-nine cases were primary rhinoplasty and 4 cases were secondary rhinoplasty.No short-term complications including hemorrhage and infection occurred in 53 patients.All patients were followed up for 6-12 months.There were statistically significant differences in nasofrontal angle,nasorostral angle,nasolabial angle,columella lobular angle,ratio of tip projection to the length of the nose and ratio of the length of the infratip lobule to the length of the nasal columella(P<0.01),which sugguested that aesthetic defects of the nose were corrected and no obvious deflection and rotation of nasal tip occured.VAS score and ROE score postoperatively were 7.6�

关 键 词：鼻成形术 肋软骨 移植 自体 支架 推顶式结构 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]