3D打印鼻前庭支撑扩张在前鼻孔狭窄治疗中的应用  

Application of 3D printed nasal vestibular support in the treatment of anterior nostril stenosis

作　　者：汪涛[1] 陈东[1] 蔡伟宇[2] 徐洲[1] 王钟颖[1] 王珮华[1] 于洋 WANG Tao;CHEN Dong;CAI Weiyu;XU Zhou;WANG Zhongying;WANG Peihua;YU Yang(Department of Otolaryngology Head and Neck Surgery,Shanghai Ninth People's Hospital,School of Medieine,Shanghai Jiao Tong University,Shanghai,200011,China;Department of Prosthodontics.Shanghai Ninth People's Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai,200011,China;Department of 3D Printing Center.Shanghai Ninth People's Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai,200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院耳鼻咽喉头颈外科,上海200011 [2]上海交通大学医学院附属第九人民医院口腔修复科,上海200011 [3]上海交通大学医学院附属第九人民医院3D打印中心,上海200011

出　　处：《临床耳鼻咽喉头颈外科杂志》2022年第10期746-752,共7页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：上海交通大学医学院附属第九人民医院临床研究助推计划(临+计划)(No:JYLJ202009)。

摘　　要：目的:运用3D打印鼻前庭支撑器,评价其对鼻孔狭窄治疗后鼻腔通气功能和鼻孔形态恢复的疗效。方法:选择38例单侧外伤性鼻前庭区狭窄的患者,在术后予以3D打印鼻前庭支撑器扩张治疗,分别从主观评价指标、客观的局部形态结构参数和数值模拟鼻腔气流动力学参数等方面来评价术前和治疗后鼻腔局部形态和功能恢复情况。结果:鼻前庭支撑器扩张治疗后的患者鼻塞主观和鼻孔对称性满意度VAS评分均较术前有不同程度的改善;鼻孔形态学参数显示Δ_(长轴比值)和Δ_(短轴比值)在支撑扩张治疗后(0.09±0.09和0.16±0.13)均较手术前(0.21±0.20和0.28±0.21)明显减小(P<0.01),并且狭窄侧的鼻瓣区截面积由术前的(0.40±0.27)cm^(2),增加到治疗后的(0.71±0.26)cm^(2),差异有统计学意义(P<0.01);整个狭窄侧鼻腔鼻阻力也由手术前的(0.036±0.024)Pa·s/mL降低到治疗后的(0.022±0.008)Pa·s/mL,差异有统计学意义(P<0.01),总鼻腔鼻阻力从术前的(0.033±0.020)Pa·s/mL降低到治疗后的(0.021±0.007)Pa·s/mL(P<0.01);鼻腔气流温湿度调节功能参数[鼻腔加温效率(NWE)和鼻腔加湿效率(NHE)]结果显示,支撑扩张治疗后狭窄侧鼻腔的气流温湿度调节作用由术前的NWE_(狭窄侧)(97.94±1.97)%和NHE_(狭窄侧)(96.19±2.94)%下降到治疗后的NWE_(狭窄侧)(95.92±2.8)%和NHE(94.55±4.17)%,差异有统计学意义(P<0.01),对于整个鼻腔气流温湿度调节作用影响较小(P>0.05)。结论:3D打印鼻前庭支撑器用于前鼻孔狭窄患者的术后支撑扩张治疗能体现个性化治疗的优势并让患者获得较满意的疗效,并且使用个性化设计的3D打印鼻前庭支撑器能够使前鼻孔外形和鼻腔正常的通气功能均有较好的恢复,其临床应用前景较好。Objective:To evaluate the efficacy of 3D printed nasal vestibular support on the recovery of nasal ventilation function and nostril shape after nostril stenosis treatment.Methods:Thirty-eight patients with unilateral traumatic nasal vestibular stenosis were selected and treated with 3D printed nasal vestibular support after operation.Subjective evaluation indicators,objective nostril local morphological and structural parameters,and nasal airflow dynamics parameters by numerical simulation were used.To evaluate the nostril morphological and nasal functional recovery after treatment.Results:The subjective nasal congestion and nostril symmetry satisfaction VAS scores of the patients after nasal vestibular support treatment were improved to varying degrees compared with those before surgery;The nostril morphological parameters showed that the Δ_(long-axis ratio) and Δ_(short-axis ratio) were significantly decreased after nasal vestibular support therapy(0.09±0.09 and 0.16±0.13)compared with those before surgery(0.21±0.20 and 0.28±0.21)respectively(P<0.01).And the cross-sectional area of the nasal valve on the stenotic side nasal cavity increased from(0.40±0.27)cm^(2) before operation to(0.71±0.26)cm^(2) after treatment(P<0.01);The nasal resistance on the stenosis side nasal cavity also decreased from(0.036±0.024)Pa·s/mL before operation to(0.022±0.008)Pa.s/mL after treatment(P<0.01),and the total nasal resistance was decreased from(0.033±0.02)Pas/mL before operation to(0.021±0.007)Pa.s/mL after treatment(P<0.01);It also showed that NWE(nasal warming efficiency)and NHE(nasal humidification efficiency)on the stenotic side nasal cavity were significantly decreased after nasal vestibular support therapy([95.92±2.8]%and[94.55±4.17]%)compared with those before surgery([97.94±1.97]%and[96.19±2.94]%)respectively(P<0.01).Conclusion:The 3D printed nasal vestibular support for postoperative support treatment on patients with anterior nostril stenosis can reflect the advantages of personalized treatment and all

关 键 词：3D打印 前鼻孔狭窄 数值模拟 视觉模拟量表评分 鼻阻力 

分 类 号：R765[医药卫生—耳鼻咽喉科]