一种新型的保留鼻中隔外组织仿生支架在鼻整形中的应用  

A novel bionic stent for external septal retention in East Asian rhinoplasty

作　　者：王先成[1] 王姝元 向星宇 宋丹丹 余子迪 孙杨[1] 熊祥[1] 孟宪熙 李文波 易忠杰 乔治华 Wang Xiancheng;Wang Shuyuan;Xiang Xingyu;Song Dandan;Yu Zidi;Sun Yang;Xiong Xiang;Meng Xianxi;Li Wenbo;Yi Zhongjie;Qiao Zhihua(Department of Plastic and Aesthetic(Burn)Surgery,the Second Xiangya Hospital,Central South University,Changsha 410011,China)

机构地区：[1]中南大学湘雅二医院整形美容外科(烧伤科),长沙410011

出　　处：《中华整形外科杂志》2024年第7期779-786,共8页Chinese Journal of Plastic Surgery

基　　金：国家自然科学基金(82272283)。

摘　　要：目的探讨保留鼻中隔外组织仿生支架在鼻整形中的应用效果。方法回顾性分析2022年1月至2023年7月,中南大学湘雅二医院整形美容外科(烧伤科)收治的采用自体肋软骨鼻中隔外组织仿生支架行鼻综合整形术患者临床资料。采用鼻小柱V形切口,向两侧鼻翼内延续成飞鸟形切口入路,术中采取第6或7肋软骨雕刻成鼻小柱支撑、鼻中隔外、帽状和盾牌移植物,其中鼻小柱支撑及鼻中隔外移植物按榫卯结构构成保留鼻中隔外组织仿生支架延长鼻小柱及加强鼻中隔,帽状移植物成形鼻尖及其上覆盖腹直肌筋膜柔化鼻尖,盾牌移植物使得鼻尖下小叶饱满,将膨体雕刻成形后置入鼻背间隙以抬高鼻背。观察患者术后效果及并发症情况,采用鼻整形效果评价量表(ROE)和视觉模拟评分法(VAS)对患者进行满意度调查,术前、后量表评分比较采用配对样本t检验。测量患者术前、后鼻唇角和鼻尖突出度评估鼻支架稳定性,术前、后鼻唇角比较采用配对样本t检验,鼻尖突出度比较采用配对样本Wilcoxon符号秩和检验。P<0.05为差异有统计学意义。结果共纳入33例初鼻整形患者,男4例,女29例,平均年龄23.8岁(15~42岁)。随访时间(14.5±4.7)个月(3~21个月),33例患者术后恢复顺利,未发生感染、出血等短期并发症,术后鞍鼻、鼻小柱偏斜、鼻翼双侧不对称、双侧鼻翼基底凹陷、鼻尖圆顿等鼻美学缺陷得以改善。满意度调查结果:ROE和VAS术后评分明显高于术前[(17.92±2.56)分vs.(12.78±3.14)分]和[(8.08±1.66)分vs.(5.15±1.99)分],差异均有统计学意义(P均<0.05),87.9%(27/33)的患者对鼻部美观及功能结果表示满意;33例患者术前、后的鼻唇角[(87.28±2.58)°vs.(97.64±1.95)°]、鼻尖突出度[1.88(1.78,1.95)cm vs.2.16(2.01,2.32)cm]比较,差异均有统计学意义(P均<0.05)。结论鼻整形手术中采用保留鼻中隔外组织仿生支架的方式,术中无需剥离暴露�Objective To investigate the application effects of a novel framework:the external septal retention bionic framework in East Asian rhinoplasty.Methods A retrospective analysis was performed based on the clinical data of the patients who received treatments in Department of Plastic and Aesthetic(Burn)Surgery,the Second Xiangya Hospital,Central South University from January 2022 to July 2023 using an external septal retention bionic framework with autologous costal cartilage rhinoplasty.The patients were all treated with a V-shaped incision at the nasal columella,which continued to both sides of the nose to form a bird-shaped incision.During the operation,the sixth or seventh costal cartilage was sculpted to form the nasal columella support grafts(sturt),external nasal septal graft,cap grafts,and shield grafts,in which the nasal column support graft and external nasal septal graft were implanted in a mortise-and-tenon joint structure to form a septum bionic retained external stent in order to lengthen the nasal columellar column and strengthen the septum.A capsular graft was used to shape the tip of the nose and the rectus abdominis fascia was covered to soften the tip of the nose,and the shield grafts were used to fill out the subnasal lobules.A bulb was sculpted,shaped and implanted in the dorsal space to elevate the nasal dorsum.To observe the postoperative results and complications,a postoperative satisfaction survey was completed using the rhinoplasty outcome evaluation(ROE)and the visual analogue scale(VAS)with regular follow-up.Comparison of preoperative and postoperative scale scores was performed using paired samples t-test.Nasal stent stability was assessed by measuring the patients’preoperative and postoperative nasolabial angle and nasal tip protrusion.The comparison of preoperative and postoperative nasolabial angle was performed using the paired-sample t-test,and the comparison of nasal tip protrusion was performed using the Wilcoxon signed rank-sum test,P<0.05 considered a statistically significant

关 键 词：鼻成形术 肋软骨 鼻支架 肋软骨支架 鼻中隔外支架 

分 类 号：R62[医药卫生—整形外科] R765.9[医药卫生—外科学]