先天性耳廓畸形的自愈性及耳廓矫正器治疗效果分析

Self-healing of congenital auricular deformity and efficacy of auricle correctors

目的:探讨先天性耳廓畸形(CAD)患儿的自愈性及采用耳廓矫正器进行治疗的效果。方法:以2020年1至12月在南通大学附属妇幼保健院出生的CAD患儿为研究对象,根据患儿家长意愿进行分组:不同意采用耳廓矫正器进行治疗但愿意接受随访者纳入观察组,在出生后1个月和1年通过电话或微信进行随访,统计患儿耳廓自愈比例(痊愈和有效耳数占该组患耳总数的比例);同意采用耳廓矫正器进行治疗者纳入无创矫正组,并根据患儿初始矫正年龄分为≤7 d、8~28 d和>28 d 3个亚组,该组患儿采用国产耳廓矫正器进行治疗,在治疗结束后1个月和1年通过电话或微信进行随访,统计耳廓治疗有效比例(痊愈和有效耳数占该组患耳总数的比例),并对初始矫正年龄≤7 d、8~28 d、>28 d 3个亚组的耳廓矫正器佩戴时间进行统计分析,3组间总体比较采用方差分析,组间两两比较采用LSD-t检验,P<0.05为差异有统计学意义。结果:观察组共纳入43例患儿(71只耳),男21例,女22例,出生后(2.1±0.3)d,左侧34只,右侧37只。无创矫正组纳入24例患儿(41只耳),男8例,女16例,出生后(29.1±23.8)d,左侧20只,右侧21只;初始矫正年龄≤7 d组有6例(10只耳),8~28 d组有6例(9只耳),>28 d组有12例(22只耳)。通过随访观察,43例观察组患儿(71只耳)出生后1个月和1年自愈比例分别为29/71和30/71,其中垂耳分别为23/31和24/31,扇贝耳均为3/6,复合畸形均为3/3,其他畸形均为0。24例无创矫正组患儿(41只耳)在治疗结束后1个月和1年有效比例分别为41/41和35/41,其中耳轮畸形均为12/12,垂耳均为3/3,杯状耳分别为7/7和5/7,扇贝耳均为4/4,环缩耳分别为6/6、5/6,招风耳分别为2/2和0,复合畸形分别为6/6和5/6,小耳畸形(Ⅰ度)均为1/1,治疗结束后1年共有4例患儿(6只耳)出现了反弹。初始矫正年龄≤7 d、8~28 d和>28 d 3组患儿耳廓矫正器佩戴时间分别为(31.8±11.2)d、(31.3±10.1)d和(41.8±13.8)d,3组比较差异有统计学意义(F=3.42,P=0.043);≤7 d与8~28 d组间比较差异无统计学意义(P=0.936),≤7 d与>28 d(P=0.043)、8~28 d与>28 d(P=0.041)组间分别比较,差异均有统计学意义。结论:CAD具有一定的自愈性,其中垂耳、扇贝耳的自愈能力较高;国产耳廓矫正器治疗CAD具有较好的效果,初始矫正年龄越大需要的矫正时间越长,CAD类型对矫正效果有一定的影响。

Objective To investigate the self-healing of congenital auricular deformity(CAD)and the efficacy of the auricle corrector in infants.Methods The infants with CAD who were born in the Affiliated Maternity and Child Health Care Hospital of Nantong University from January to December 2020 were collected.The patients who disagreed with the use of auricle corrector were included in the observation group.The patients were followed up on the day of one month and one year after birth by phone or WeChat,and the self-healing rate(the proportion of the number of ears found to be healed in the total number of affected ears after follow-up)of auricle was calculated.The patients treated with auricle corrector were included in the non-invasive correction group,which was treated with domestic auricle corrector.And according to the initial correction age,the patients were divided into≤7 d,8-28 d and>28 d three subgroups.The patients were followed up on the day of one month and one year after treatment by phone or WeChat,and the effective rate(the proportion of healed ears to the total number of affected ears after treatment)was calculated.And statistical analysis was used in the three subgroups of initial correction age≤7 d,8-28 d,>28 d.Variance analysis was used for general comparison between three groups,and LSD-t test for the comparison between two groups.P<0.05 was considered statistically significant.Results A total of 43 children(71 ears,34 left ears and 37 right ears)were included in the observation group,including 21 males and 22 females,(2.1±0.3)days after birth.In the non-invasive correction group,24 children(41 ears,20 left ears and 21 right ears)were included,including 8 males and 16 females,(29.1±23.8)days after birth.There were 6 cases(10 ears)in the initial correction age group≤7 days,6 cases(9 ears)in the 8-28 days group,and 12 cases(22 ears)in the>28 days group.In the observation group(71 ears),the rates of self-healing on the day of one month and one year after birth were 29/71 and 30/71,respectively,including 23/31 and 24/31 for lop ear,3/6 for Stahl’s ear,3/3 for complex deformity,and 0 for other ear deformities.The effective rates were 41/41 and 35/41 one month and one year after treatment in the 24 children(41 ears)in the non-invasive correction group,respectively.Among them,the helical rim deformity was 12/12,lop ear 3/3,cup ear 7/7 and 5/7,Stahl’s ear 4/4,contracted ear 6/6,5/6,prominent ear 2/2 and 0,the complex deformity 6/6 and 5/6,and microtia(Ⅰ)1/1.The auricular deformities reoccurred in a total of 4 children(6 ears)1 year after the end of treatment.According to the initial correction age into three groups,the treatment duration of the auricle corrector was(31.8±11.2)days,(31.3±10.1)days and(41.8±13.8)days,and the difference among the three groups was statistically significant(F=3.42,P=0.043).There was no statistical significance between the groups≤7 days and 8-28 days(P=0.936),but there was statistical significance in the treatment duration between the groups≤7 days and>28 days(P=0.043),and between the groups 8-28 days and>28 days(P=0.041).Conclusion CAD can self-heal to some extent.Self-healing rate is higher in lop ear and Stahl’s ears.The domestic auricle corrector has a good effect on CAD.The older the age of initial correction is,the longer the time of correction is.The type of CAD has a certain influence on the correction effect.