自体肋软骨移植技术修复Binder综合征的疗效评价

Effectiveness of autologous costal cartilage transplantation in repair of Binder's syndrome

目的探讨自体肋软骨移植技术修复Binder综合征的技术要点及疗效。方法 2012年6月—2017年6月,收治8例Binder综合征患者。男3例,女5例;年龄16~31岁,平均22岁。患者面部均呈Binder综合征典型表现。采用自体肋软骨移植技术,将肋软骨雕刻为鼻背盖板、鼻小柱支撑及鼻基底填充进行移植。手术前后摄患者正面观、侧面观以及基底观标准照片,测量鼻背长度、小柱-小叶比、鼻额角、小柱-上唇角、鼻尖突出率、鼻根突出度,并进行统计学分析,评价该术式修复Binder综合征的疗效。结果术后切口均Ⅰ期愈合,未出现急性期感染等。患者均获随访,随访时间6~36个月,平均18个月。术后1例出现上唇异物感,1例发生胸廓切口瘢痕增生。术后患者鼻部形态明显改善,鼻与上唇及面部的协调关系恢复。6例完成术后参数测量,术后6个月鼻背长度、小柱-小叶比、鼻额角、小柱-上唇角、鼻尖突出率、鼻根突出度均较术前显著改善,差异有统计学意义(P<0.05)。术后6个月鼻背长度、鼻尖突出率和鼻根突出度与正常值比较,差异均无统计学意义(P>0.05);小柱-小叶比与正常值比较,差异有统计学意义(P<0.05)。结论自体肋软骨移植技术修复Binder综合征可明显改善患者鼻部及中面部外观,效果稳定。

Objective To investigate the technical points and effectiveness of autogenous costal cartilage transplantation in repair of Binder＇s syndrome. Methods Between June 2012 and June 2017, 8 cases of Binder＇s syndrome were admitted. There were 3 males and 5 females, aged 16-31 years（mean, 22 years）. All patients were conformed to the typical manifestations of Binder＇s syndrome. The autogenous costal cartilage was harvested and carved into the nasal dorsum graft, nasal column graft, and nasal basement graft. Before and after operation, standard pictures of the anterior view, lateral view, and base view were taken to measure facial related parameters of nasal dorsum length, nasal columella-lobule ratio, nasofrontal angle, nasal columella-upper lip angle, nasal tip projection rate, and nasion projection. Then the effectiveness of this surgical procedure for Binder＇s syndrome was evaluated.Results All incisions healed by first intention without acute infections. All patients were followed up 6-36 months, with an average of 18 months. The foreign body sensation in upper lip and scar hyperplasia in thoracic incision occurred in1 case, respectively. The nasal morphology improved significantly and the coordinated relationships of the nose with the upper lip and face were restored postoperatively. Postoperative parameter measurements were taken in 6 cases. The nasal dorsum length, nasal columella-lobule ratio, nasofrontal angle, nasal columella-upper lip angle, nasal tip projection rate,and nasion projection at preoperation were significantly improved when compared with the values at 6 months after operation（P0.05）. The difference in nasal dorsum length, nasal tip projection rate, and nasion projection between actual values at 6 months after operation and normal values was no significant（P〈0.05）. There was significant difference in nasal columella-lobule ratio between actual value at 6 months after operation and normal value（P〈0.05）.Conclusion Autogenous costal cartilage transplantation in repair of Binder＇s syndrome can obviously improve patients＇ appearance of the external nose and middle face, and obtain the persistent effectiveness.