保留软骨膜的肋软骨皮质片两种切取方法的对比研究

A comparative study of two different methods of the costal cartilage cortex harvest with perichondrium preserved

目的:比较保留软骨膜的肋软骨皮质片的两种不同切取方法对鼻整形患者围手术期的影响,探讨一种简单且创伤较小的肋软骨皮质片切取方法的临床效果。方法:纳入2019年9月至2020年12月上海时光整形外科医院收治的应用鼻尖"双拱"支架联合假体综合鼻整形患者,采用随机数字表法随机分为观察组和对照组。观察组仅切取保留软骨膜的肋软骨皮质片,保留肋软骨的连续性;对照组则先切取整块肋软骨,保留浅层肋软骨膜,再修剪成保留软骨膜的肋软骨皮质片。两组患者均由同组临床医师完成手术。比较两组的手术时间、术中出血量、切口长度、术后6、24、72 h和1周的胸部疼痛程度及并发症的发生等围手术期情况。胸部疼痛程度采用视觉模拟评分法(VAS)进行评定。两组计量资料采用t检验进行分析,计数资料采用χ^(2)检验进行分析。结果:观察组和对照组各纳入61例患者。其中,观察组男3例(4.9%),女58例(95.1%),年龄(28.6±5.4)岁,体质量指数(21.76±1.65)kg/m 2;对照组男2例(3.3%),女59例(96.7%),年龄(45.8±5.7)岁,体质量指数(22.25±1.47)kg/m 2。两组患者的性别构成、年龄、体质量指数的差异均无统计学意义(P值均>0.05)。两组患者获取的肋软骨皮质片均能够完好制作鼻尖双拱支架。对照组出现2例胸膜破裂,经有效处理后,预后良好,无血肿、感染等并发症发生;观察组无血肿、感染、胸膜损伤等并发症发生。观察组的手术时间、切口长度、术中出血量均明显小于对照组[(18.54±3.62)min vs.(25.75±3.75)min;(1.68±0.26)cm vs.(2.16±0.32)cm;(16.79±7.86)ml vs.(25.46±8.49)ml;P值均<0.05]。术后6、24、72 h和1周,观察组的VAS评分均低于对照组[(2.76±0.62)分vs.(3.87±0.68)分;(2.37±0.45)分vs.(3.12±0.55)分;(1.76±0.45)分vs.(2.57±0.53)分;(1.17±0.44)分vs.(1.85±0.51)分;P值均<0.05]。结论:与传统整块切取肋软骨方法相比,采用保留肋软骨连续性的方法切取保留肋软骨膜的肋软骨皮质片,创伤小,术中出血少,手术过程简化,可缩短手术时间,并显著减轻术后胸部疼痛程度。

Objective To compare two different methods for the harvest of the costal cartilage cortical slice with perichondrium preserved for rhinoplasty patients,and to explore a simple and less invasive method for the costal cartilage cortical slice.Methods From September 2019 to December 2020,the rhinoplasty patients using the techniques of nasal tip"double arch"stent combined with prosthesis were selected in Shanghai Time Plastic Surgery Hospital,they were randomly divided into observation group and control group.In the observation group,only the cortical slice of costal cartilage with perichondrium was cut and the continuity of costal cartilage was preserved.While in the control group,with the superficial perichondrium preserved,the whole costal cartilage was dissected first,and then pruned it and harvested the cortical slice of costal cartilage with perichondrium.The operation were performed by the same clinicians in both groups.Different variables were compared between the two groups,including the operation time,intraoperative blood loss,length of incision,the degree of chest pain after postoperative 6,24,72 h,1 week,the incidence of intraoperative complications and so on.The severity of chest pain was assessed by visual analogue scale(VAS).The measurement data of the two groups were analyzed by t-test,and the enumeration data were analyzed byχ^(2) test.Results For both observation group and the control group,61 patients were included.In the observation group,there were 3 males(4.9%)and 58 females(95.1%),aged(28.6±5.4)years old,and BMI(21.76±1.65)kg/m2.In the control group,there were 2 males(3.3%)and 59 females(96.7%),aged(45.8±5.7)years old,and BMI(22.25±1.47)kg/m2.There were no significant differences in gender composition,age and BMI between the two groups(P>0.05).The double arch stent of nasal tip could be made by the costal cartilage cortical slices obtained in the two groups.In the control group,two cases of pleural rupture occurred and their prognosis was good after effective treatment,with no complications such as hematoma,infection or pleural injury.In the observation group,there were no complications such as hematoma,infection or pleural injury.The operation time,incision length and intraoperative blood loss in the observation group were significantly lower than those in the control group[(18.54±3.62)min vs.(25.75±3.75)min;(1.68±0.26)cm vs.(2.16±0.32)cm;(16.79±7.86)ml vs.(25.46±8.49)ml;P<0.05].The VAS score in the observation group was lower than that in the control group after postoperative 6,24,72 h,1 week[(2.76±0.62)vs.(3.87±0.68)scores;(2.37±0.45)vs.(3.12±0.55)scores;(1.76±0.45)vs.(2.57±0.53)scores;(1.17±0.44)vs.(1.85±0.51)scores;P<0.05].Conclusions Compared with the conventional method of whole costal cartilage harvest,the method of harvesting the costal cartilaginous cortical slice with the costal perichondrium preserved and preserving the continuity of the costal cartilage can reduce the trauma and bleeding,shorten the operation time,simplify the operation process,and significantly reduce the postoperative chest pain.