非扩张整体支架耳廓再造术——"直立法"耳廓再造术  

Non-expansion whole framework ear reconstruction for microtia

作　　者：何乐人 杨锦秀 姜栋文 范姝君 栾文康 蒋馨谊 冯竞伟 胡忠林 He Leren;Yang Jinxiu;Jiang Dongwen;Fan Shujun;Luan Wenkang;Jiang Xinyi;Feng Jingwei;Hu Zhonglin(Department of Ear Reconstruction,Plastic Surgery Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100144,China Research Ward,Plastic Surgery Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100144,China)

机构地区：[1]中国医学科学院北京协和医学院整形外科医院外耳整形再造科,北京100144 [2]中国医学科学院北京协和医学院整形外科医院研究型病房,北京100144

出　　处：《中华整形外科杂志》2024年第12期1299-1305,共7页Chinese Journal of Plastic Surgery

基　　金：中国医学科学院重大协同创新项目(2021-I2M-1-001);首都卫生发展科研专项(2022-2-4042)。

摘　　要：目的探讨非扩张整体支架耳廓再造术(又称"直立法"耳廓再造术)的临床应用效果。方法回顾性分析2022年1月至2024年1月于中国医学科学院整形外科医院外耳整形再造科行"直立法"耳廓再造术的先天性小耳畸形患者资料。手术分两期进行。一期耳廓再造手术主要包括:自体肋软骨采取、包含耳甲立体高度和主要亚结构的整体耳支架制备、耳垂转位、前蒂乳突区皮瓣及筋膜瓣形成、整体耳支架移植、皮瓣与筋膜瓣交叠覆盖耳支架、耳后创面皮片移植修复。6个月后进行二期手术, 主要包括:耳屏成形、耳甲腔及外耳门模拟、残余毛囊直视下去除等。术后6个月随访时, 评价再造耳的形态结构及并发症情况。形态结构评价包括皮肤颜色(耳正面以及耳背面和植皮区2部分分别评价)、再造耳亚结构呈现情况、切口瘢痕及毛发情况4项, 单项评分0~2分, 总分0~10分, 其中, 9~10分表示优秀, 6~8分表示良好, 3~5分表示一般, 0~2分表示差。数据采用描述性统计分析。结果共纳入49例患者(49耳), 男37例, 女12例;年龄6~33岁;右耳34例, 左耳15例;Nagata分型:耳垂型30例, 耳甲腔型5例, 小耳甲腔型14例。随访6~13个月, 平均10.6个月。1例患者一期术后1个月软骨支架外露, 手术修复后恢复良好。术后随访时, 患者再造耳正面肤色接近正常, 亚结构清晰, 耳后植皮区恢复良好, 再造耳与健侧基本对称, 9例(18.4%)耳后乳突区有瘢痕增生, 9例(18.4%)再造耳正面可见毛发生长。形态结构评价:优秀8例(16.3%), 良好36例(73.5%), 一般4例(8.2%), 差1例(2.0%)。结论 "直立法"耳廓再造术治疗周期短、效果稳定, 可以作为小耳畸形耳廓再造的可选择术式之一。Objective:To explore the clinical effect of non-expansion whole framework ear reconstruction for microtia(referred to as the NEWF ear reconstruction).Methods:The clinical data of congenital microtia patients underwent NEWF ear reconstruction at Department of Ear Reconstruction,Plastic Surgery Hospital,Chinese Academy of Medical Sciences were retrospectively analyzed.This advanced method used a tissue non-expansion approach,employing a double flap consisting of preauricular skin flap and fascia flaps,to fabricate and elevate the ear framework in the first stage concurrently.In the subsequent stage,residual ear tissues were utilized to reconstruct key elements such as the tragus,crus of the helix,cavum concha,and so on.At 6 months follow-up,the effectiveness of the reconstructed ear was assessed based on its aesthetic outcomes and complications.Aesthetic outcomes evaluation included 4 items:skin color(front of ear,back of ear and skin graft area were evaluated respectively),appearance of reconstructed ear substructure,scar of incision and hair condition.The individual score was 0-2 points,total scores from 0 to 10,with scores of 9-10 signifying excellent,6-8 good,3-5 moderate,and 0-2 poor.The data were analyzed by descriptive statistics.Results:Ear reconstruction was performed on 49 unilateral microtia cases,aged 6-33 years,including 37 males and 12 females,34 right ears and 15 left ears.According to the Nagata classification:30 cases were lobule-type,5 cases were conchal-type,and 14 cases were small conchal-type.The follow-up period averaged 10.63 months,ranging from 6 to 13 months.One patient experienced exposure of the framework 1 month after the first stage surgery,then recovered well after surgery.The skin color of the front side of the reconstructed ear was close to normal,the substructure was clear,the skin graft area behind the ear recovered well,and the reconstructed ear was basically symmetrical with the healthy side.9 cases(18.4%)had scar hyperplasia in the mastoid area behind the ear.9 cases(18.4%)had h

关 键 词：小耳畸形 耳廓再造术 "直立法"耳廓再造术 自体肋软骨 

分 类 号：R76[医药卫生—耳鼻咽喉科]