改良旋转推进法在单侧不完全性唇裂中的应用效果

Application of modified rotating advancing method in unilateral incomplete cleft lip

目的探讨改良旋转推进法修复单侧不完全性唇裂的临床应用效果。方法自2017年7月至2020年6月,河北医科大学口腔医学院口腔医院口腔颌面外科共收集16例单侧不完全性唇裂患儿,均采用改良旋转推进法进行修复,分别于术前、术后即刻及术后6个月拍摄正面照及下颌抬颏位照,采用Asher-Mc Dade 5分制量表对鼻唇形态进行主观评价,对健患侧鼻翼点、鼻翼基脚点、唇峰点、口角点及鼻小柱中点的偏离程度进行客观测量,采用SPSS 21.0进行统计学分析。结果16例患儿均一期愈合,随访6个月,主观评价结果:术前、术后即刻、术后6个月的平均得分分别是(4.59±0.42)分、(2.28±0.31)分和(2.00±0.45)分,术后即刻与术前得分比较,差异有统计学意义(P<0.01),术后即刻与术后6个月得分比较,差异无统计学意义(P=0.090);客观测量结果:术前健患侧鼻翼点、鼻翼基脚点、唇峰点到面中线的距离比较,差异有统计学意义(P<0.05),术后即刻及术后6个月健患侧鼻翼点、鼻翼基脚点、唇峰点、口角点到面中线的距离比较,差异无统计学意义(P>0.05);术后即刻健患侧鼻翼点、鼻翼基脚点、唇峰点距面部中线的距离与术前比较,差异有统计学意义(P<0.05);术后即刻与术后6个月比较,差异无统计学意义(P>0.05);术后即刻、术后6个月与术前鼻小柱中点的回归率比较,差异有统计学意义(P<0.05),从14.16%增加到27.29%。结论采用改良旋转推进法修复单侧不完全性唇裂,术后可恢复鼻唇部对称性,且术后6个月效果稳定。

Objective To explore the clinical efficacy of modified rotating advancing method in the repair of unilateral incomplete cleft lip.Methods From July 2017 to June 2020,16 patients with unilateral incomplete cleft lip were collected.All patients were repaired by modified rotating advancing method.The frontal photos and chin-lifting photos were taken before operation,immediately after operation and 6 months after operation.The Asher-Mc Dade 5-point scale was used to subjectively evaluate the shape of nose and lip,and the deviation degree of healthy and affected nasal alar point,nasal alar base point,lip peak point,mouth angle point and nasal columella midpoint was objectively measured.The SPSS 21.0 was used for statistical analysis.Results All patients healed at the first stage and were followed up for 6 months.The average scores of subjective evaluation results before operation,immediately after operation and 6 months after operation were(4.59±0.42),(2.28±0.31)and(2.00±0.45),respectively.The scores immediately after operation and before operation were significantly different(P<0.01),but there was no significant difference between immediately after operation and 6 months after operation(P=0.090).The objective measurement results before operation showed significant differences between healthy and affected sides in the distance from nasal alar point,nasal alar foot point and lip peak point to facial midline(P<0.05).Immediately after operation and 6 months after operation,there were no significant differences between healthy and affected sides in the distance from nasal alar point,nasal alar foot point,lip peak point and mouth angle point to facial midline(P>0.05).Immediately after operation and before operation,the differences between healthy and affected sides in the distance from nasal alar point,nasal alar foot point and lip peak point to facial midline were statistically significant(P<0.05).There was no significant difference between immediately and 6 months after operation(P>0.05).The regression rate of midpoint of nasal columella immediately after operation and 6 months after operation was significantly different from that before operation(P<0.05),increasing from 14.16%to 27.29%.Conclusion Modified rotating advancing method can restore the symmetry of nose and lip in the repair of unilateral incomplete cleft lip.The efficacy is stable at 6 months after operation.