可生长肋骨/肋软骨复合体移植矫正眶距增宽症的鼻畸形效果

Hypertelorisum with nasal deformities corrected by growing rib/costochondral grafts in early stage: a follow-up study

目的测量患儿经过眶距增宽症O型截骨矫正,及用肋骨/肋软骨复合体移植矫正初期鼻畸形后,眼眶及鼻部的相关参数。方法2013年1月至2018年12月,在上海交通大学医学院附属第九人民医院整复外科颅颌面治疗中心,经眶距增宽症O型截骨矫正及同时用肋骨/肋软骨复合体移植矫正初期鼻畸形60例患儿,男36例,女24例,年龄6~10岁,平均7.3岁。60例患儿在术前后1年随访时,均进行头颅CT三维扫描和拍照。通过三维测量比较其骨性内眦间距(IOD)和鼻部美学参数(鼻背宽度、鼻翼宽度、鼻背高度、鼻尖突出度/鼻长)的变化。结果60例患儿家长均对术后效果满意。三维测量显示,术后患儿IOD值由术前(39.88±1.98)mm矫正为(20.56±2.37)mm,治疗前后比较,差异有统计学意义(t=7.25,P<0.05);提示眶距增宽症状、IOD值、鼻部美学参数均有明显改善。肋骨/肋软骨复合体的吸收率16%~19%,无移植物的偏曲变形;偶见感染、脑脊液漏、发育不全等并发症,未见严重并发症。结论对于眶距增宽症的患儿用O型截骨的同时用肋骨/肋软骨复合体移植矫正初期鼻畸形可收到较好的效果。

Objective To measure the changes in the orbital and nasal parameters before and after Tessier box osteotomy with primary aesthetic rhinoplasty concurrently with byotogenous costochondral graft.Methods From 2013 to 2018,60 hypertelorism patients were treated in our craniofacial center.Correction involved a classic Tessier box osteotomy combined with aesthetic augmentation and reconstruction of the nasal dorsum using a costochondral graft.All patients underwent photographic and tomographic documentation both before and 12 months after surgery.Patients underwent morphometric analysis to document the changes in interorbital distance(IOD)and aesthetic nasal parameters,including the nasal dorsum and alar width,the nasal dorsal height,and the index of nasal apex protrusion versus nasal length.Results All patients were satisfied with the outcome of the combined orbital and nasal repair.Morphometric analysis indicated that the IOD and aesthetic nasal parameters all improved following surgery.The resorption rate of the costochondral graft was 16-19%,and graft warpage was nearly absent.Although complications so as infection,cerebrospinal fluid leak or hyposomia,no severe or life-threatening complications occurred.Conclusions Tessier box osteotomy with primary aesthetic rhinoplasty using costochondral grafts has showed to be efficacious in the treatment of patients with hypertelorism.