肋软骨跨穹窿盖板移植物联合鼻前庭V-Y推进皮瓣矫正鼻翼缘退缩畸形  

Extended trans-dome onlay graft combining nasal vestibule V-Y advancement flap for correction of alar retraction

作　　者：秦雷 曾永升 何忠波 李任 Qin Lei;Zeng Yongsheng;He Zhongbo;Li Ren(Department of Plastic Surgery,Chongqing Huamei Plastic Surgery Hospital,Chongqing 400015,China)

机构地区：[1]重庆华美整形外科医院整形科,重庆400015 [2]重庆美莱整形美容医院整形美容科,重庆400023 [3]重庆百达丽医疗美容门诊部,重庆400060

出　　处：《中华整形外科杂志》2022年第10期1160-1168,共9页Chinese Journal of Plastic Surgery

摘　　要：目的探讨应用肋软骨跨穹窿盖板移植物联合鼻前庭V-Y推进皮瓣矫正鼻翼缘退缩畸形的临床效果。方法回顾性分析2019年7月至2020年10月于重庆华美整形外科医院收治的鼻翼缘退缩患者的临床资料。取患者右侧第6或第7肋软骨制作鼻整形所需的移植物(其中包括应用肋软骨皮质部分制作的薄片状盖板移植物);切开鼻前庭时设计V形皮瓣, 在施行肋软骨鼻综合整形手术处理鼻部其他美学亚单位后, 于鼻翼皮肤及鼻前庭皮肤间沿皮下充分分离至鼻翼缘并形成囊袋样腔隙, 将盖板移植物固定于鼻尖, 两侧软骨片分别插入囊袋内, 使其为鼻翼缘下移提供支撑力, 通过V-Y推进缝合鼻前庭皮瓣为鼻翼缘下移提供软组织, 并在鼻翼内外两侧用夹板固定。术后从以下3个方面对手术效果进行评估:(1)鼻翼缘退缩改善满意度。术后由患者本人及2位未参与手术的鼻整形医生分别通过视觉模拟评分法(VAS)对鼻翼缘退缩改善程度进行评分(总分为0~10分, 9、10分为满意, 7、8分为基本满意, 0~6分为不满意), 统计术后满意例数占总例数的百分比。(2)鼻翼对称度, 即鼻翼对称例数占总例数的百分比。(3)正位标准照a/b值(a为两侧鼻翼缘退缩最高点连线-鼻尖表现点水平线间距, b为两侧鼻翼缘退缩最高点连线与鼻小柱-小叶转折点水平线间距)。采用Image J软件测量并计算正位标准照中的a/b值, a/b=1或a/b稍>1表示鼻翼缘位置正常, a/b<1为鼻翼缘退缩。应用SPSS 20.0软件进行统计分析, 鼻翼对称度术前和术后比较采用卡方检验, 正位标准照a/b值以±s表示, 术前和术后比较采用配对t检验, 不同分型组间两两比较采用SNK法, P<0.05为差异有统计学意义。结果共纳入43例鼻翼缘退缩患者, 男5例, 女38例, 年龄18~45岁, 平均27.3岁, 其中内侧型17例、中央型22例、外侧型4例。术后随访时间为1~24个月, 中位数为4个月, 随访Objective To investigate the effect of using extended trans-dome onlay graft(eTDOG)made of costal cartilage combined with nasal vestibule V-Y advancement flap for correction of alar retraction.Methods Clinical data of patients diagnosed with alar retraction at Chongqing Huamei Plastic Surgery Hospital between July 2019 and October 2020 were retrospectively analyzed.The 6th or 7th right costal cartilage was harvested,cut into pieces for grafts,including a laminar trans-dome onlay graft,made from cortex part of the rib.Then a V-shaped flap was designed on the vestibular skin.At the end of the rhinoplasty,a pocket was created along the alar rim,and the eTDOG was inserted into the pocket to push down the alar rim.Nasal vestibule V-Y advancement flap provides extra soft tissue for alar retraction correction.Splints were applied to hold the eTDOG and flap in place.Assessment of therapeutic effect was made from three aspects.First of all,therapeutic satisfaction assessment,which was made based on the visual analogue scale(VAS).VAS scoring was conducted by patients and two surgeons who were not involved in surgery.Results were divided into three categories,total satisfaction with scoring 9 or 10,partly satisfaction with scoring 7 or 8,and dissatisfaction with scoring 0-6.Subsequently,the percentage of satisfaction indeed in the total number of cases was counted.Alar symmetry assessment was also included.The percentage of cases with alar symmetry in the total number of cases.Third,the ratio(a/b)of the distance between the line defined by bilateral highest points of alar retraction and the line determined by tip-defining points(a)to that between the line determined by bilateral highest points of alar retraction and the horizontal line defined by the turning point of columella lobule(b)was calculated on frontal view.The value of a and b was measured using Image J,and a/b<1 represented absence of alar retraction.The statistical analysis was performed using SPSS version 20.0.Chi-square test was used to compare the symmetry of

关 键 词：鼻成形术 鼻翼缘退缩 肋软骨 移植 自体 鼻前庭 V-Y推进皮瓣 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]