自体脂肪移植与吻合血管股前外侧筋膜脂肪瓣移植术对PHFA面部软组织缺损疗效分析

Effect of autologous fat transplantation and anastomotic vascular anterolateral fascial fat flap transplantation for PHFA facial soft tissue defect

目的分析对比自体脂肪移植术与吻合血管股前外侧筋膜脂肪瓣(ALT)移植术在临床治疗进行性半侧颜面萎缩畸形(PFHA)中的疗效和价值。方法选取2014年8月至2017年6月间于本院接受治疗的PFHA患者共42例为研究对象,按照入院顺序单双号分为研究组(采用自体脂肪移植术)和对照组(采用ALT移植术)各21例,对比两组患者的治疗效果。结果研究组和对照组术后6个月面部非对称率[(10.96±1.35)%与(11.98±1.37)%]显著低于术前[(20.13±1.59)%和(24.65±1.81)%],差异有统计学意义(P<0.05),但两组间对比差异无统计学意义(P>0.05);研究组和对照组术后6个月患侧面部缺损体积[(14.16±2.98)ml与(8.95±4.31) ml]显著低于术前[(43.17±12.15)ml与(46.83±16.21)ml],差异有统计学意义(P<0.05),两组间对比差异无统计学意义(P>0.05);研究组患者的手术时间和住院时间均显著少于对照组,而手术次数多于对照组,差异均有统计学意义(P<0.05);研究组术后6个月的实际移植组织体积保持率[(28.12±6.11)%]低于对照组[(77.21±5.33)%],差异有统计学意义(P<0.05);两组在术后6个月的3-D偏差最大值和平均值对比中,差异均无统计学意义(P> 0.05);两组患者在术后并发症对比中,差异均无统计学意义(P>0.05);研究组的患者满意度显著优于对照组,差异有统计学意义(P<0.05);而在医师满意度和第三方满意度对比方面,差异均无统计学意义(P> 0.05)。结论自体脂肪颗粒移植术在临床治疗重症PFHA患者时能有效恢复患者的面部对称性,同时还具备手术方式简单易操作、取材丰富、手术创伤小恢复快和无排异反应等特点,值得在临床中进行广泛的推广。

ObjectiveTo evaluate the efficacy and value of autologous fat transplantation and anesthesia of the anterolateral femoral fascial flap （ALT） in the clinical treatment of progressive hemifacial atrophy （PFHA）.MethodsFrom April 2014 to June 2017, 42 patients with progressive hemi-facial wretched malformations who were treated in our hospital were randomly divided into observation group （using autologous fat transplantation）. And 21 cases with anastomotic anterolateral femoral fascial fat flap transplantation were enrolled in the control group. Then the therapeutic effect was compared between the two groups.ResultsThe rate of facial asymmetry in the observation group and the control group were （10.96±1.35）% and （11.98±1.37）% in the 6 months after operation, significantly lower than that before operation [（20.13±1.59）% and （24.65±1.81）%], and the difference was statistically significant （P〈0.05）; While there was no significant difference between the two groups （P〉0.05）. The volume of facial defect [（14.16±2.98）ml and （8.95±4.31）ml] in the observation group and the control group 6 months after operation was significantly lower than that before the operation [（43.17±12.15）ml and （46.83±16.21）ml], with statistically significantthe difference （P〈0.05）; While the difference between the two groups was not statistically significant （P〉0.05）. The operation time and hospital days in the observation group were significantly lower than in the control group, and the number of operation times was more than that of the control group （P〈0.05）. The volume retention rate of the actual transplanted tissue in the observation group was lower than that of the control group [（28.12±6.11）% vs （77.21±5.33）%], with statistically significant difference （P〈0.05）. There was no significant difference in the maximum and average 3-D deviation, as well as the the postoperative complications between the two groups at 6 months after operation （P〉0.05）. In the observation group, the satisfaction rate of the patients was significantly better than that of the control group （P〈0.05）, but there was no significant difference between the satisfaction degree of doctors and the third party （P〉0.05）.ConclusionsAutologous fat granule transplantation in the clinical treatment of severe PFHA patients can effectively restore the patient＇s facial symmetry. At the same time, it has the characteristics of simple operation, easy operation, rich material, quick recovery of surgical trauma and no rejection. It is worth widely spreading in clinical practice.