鼻成形术中肋软骨切取的不同方法对供区疼痛的影响

Influence of different costal cartilage harvest techniques on donor site pain in rhinoplasty

目的比较鼻成形术中肋软骨切取的两种不同方法对患者供区术后疼痛的影响,探索一种损伤尽可能小的肋软骨切取方法。方法2016年12月至2017年12月,南京医科大学附属友谊整形外科医院整形外科收集肋软骨移植鼻成形手术女性患者43例(年龄18~44岁,平均29.3岁),均切取右侧第7肋软骨,分为全层节段切取肋软骨组(20例)和断层切取肋软骨组(23例)。采用视觉模拟评分法(VAS)评估患者术后6、24、48、72 h肋软骨供区疼痛程度,记录伤口是否不适和并发症的发生情况。结果获取的肋软骨均成功制作鼻部整形所需移植物,43例患者胸部供区切口均一期愈合,无血肿、感染、气胸、血胸等并发症。全层节段切取组各时间点VAS评分为(5.515±1.085)分、(5.250±1.302)分、(5.315±1.117)分、(4.895±1.042)分。均高于断层切取组相应时间点评分(2.665±0.7130)分、(2.261±0.642)分、(1.609±0.398)分、(1.383±0.514)分,两组不同时间点的VAS评分差异有统计学意义(F=36.788,P<0.05)。结论采用保留肋软骨上缘的方法切取断层肋软骨,可显著降低术后供区疼痛。

Objective To seek a minimally invasive method for costal cartilage harvest by using two different costal cartilage harvest techniques in rhinoplasty and to compare their influence on donor site pain.Methods Fourty-three female patients who underwent costal cartilage harvest for rhinoplasty from Dec.2016 to Dec.2017 were randomly divided into two groups.We harvested the right side seventh costal cartilage in both groups.In control group,we harvested a full thickness segment of costal cartilage in each patient,whereas we harvested a split thickness segment of costal cartilage by preserving the superior strip in experimental group.Donor site pain was evaluated via visual analogue scale(VAS)6 h,24 h,48 h and 72 h after surgery.Results The VAS scores(mean±standard deviation)at different time points in the control group were(5.515±1.085),(5.250±1.302),(5.315±1.117)and(4.895±1.042).And in the experimental group,they were(2.665±0.713),(2.261±0.642),(1.609±0.398)and(1.383±0.514),respectively.The VAS scores at different time points were significantly higher in the control group than that in the experimental group(P<0.05).Conclusions The superior strip preserved costal cartilage harvest technique significantly reduces postoperative donor site pain.