手风琴技术与多层叠加技术比较自体肋软骨隆鼻的效果

Nasal dorsum augmentation using autologous costal cartilage:accordion technique or multilayer oppositional suture technique

目的探讨手风琴技术与多层叠加技术预防自体肋软骨移植抬高鼻背时,移植体扭曲、变形、吸收的效果。方法2016年1月至2019年12月,海军军医大学附属长征医院整形外科收治行自体肋软骨鼻整形或修复患者119例,男7例、女112例;年龄20~45岁,平均27岁。鼻背植入体分别用手风琴技术(accordion technique,AT)和多层叠片对翻缝合技术(multilayer oppositional suture technique,MOST)。定期随访记录鼻背扭曲、变形情况并评估手术效果。结果术后随访3~28(12.1±5.5)个月,鼻背肋软骨经处理后扭曲和变形发生率,MOST组1例(2.4%)明显低于AT组6例(7.8%)。对美学和功能结果(包括鼻塞)满意度评分,AT组患者和MOST组患者分别为(3.3±0.7)分和(3.4±0.6)分;医师独立评分,AT组(3.2±0.8)分,MOST组(3.3±0.6)分;两组比较差异无统计学意义(P>0.05)。结论与AT相比,肋软骨MOST处理后的鼻背肋软骨植入体扭曲和变形等并发症发生率更低,可以是患者鼻背抬高的较好选择。

Objective To explore the effect of two different treatment methods of dorsum implants using autologous costal cartilage,accordion technique(AT)and multilayer oppositional suture technique(MOST),in preventing complications such as distortion and warping of the grafts.Methods From January 2016 to December 2019,119 patients underwent rhinoplasty with autologous costal cartilage as the dorsum implant.The dorsum implants were processed by two different techniuqes.Medical charts and operative records were reviewed to summary the complications,especially warping.Patients′subjective satisfaction and doctors′objective measurement of the postoperative nasal appearance were evaluated with a grading system.Results The postoperative follow-up duration was 6 to 28 months.Graft exposure,mobility,or significant resorption,pneumothorax or significant donor-site pain were not observed.The warping rate was higher in the AT(7.8%,6/77)than in the MOST(2.4%,1/42)group,although not significantly.Overall,there were no differences in overall patient functional and aesthetic satisfaction between the two groups.Conclusions Multilayered oppositional suture technique for the autologous costal cartilage grafting may minimize the complication of graft warping and might be an effective alternative for nasal dorsal augmentation,particularly in Asian patients.