隆鼻术中植入材料对术后并发症的影响

Effect of implant materials on postoperative complications during rhinoplasty

目的:探讨隆鼻术中自体软骨和人工材料植入物对术后并发症的影响。方法:2015年1月至2018年10月,在东莞韩美美容医院美容外科接受隆鼻术女性患者447例,年龄18~52(26.8±6.9)岁,根据植入体材料分为自体软骨组334例和人工材料组113例。比较两组患者术后并发症,分析并发症发生的相关因素。结果:随访患者3~24个月,平均19.4个月,447例患者中51例(11.4%)患者出现术后并发症,人工材料组患者功能失败率(16.8%)显著高于自体软骨组(9.6%)(χ^(2)=4.17,P=0.037)。自体软骨组中,最常见并发症是鼻体轮廓不规则共10例,占3.0%;感染8例,占2.4%。人工材料组中最常见并发症是感染共6例(5.3%)和假体显露3例(2.7%)。随访3~24个月,自体软骨组术后并发症32例(16.8%),显著高于人工材料组19例(9.6%),两组差异有统计学意义(log-rankχ^(2)=4.37,P=0.039)。多因素COX危险因素分析结果显示,吸烟史(HR=1.78,95%,CI:1.21~2.29,P=0.004)、既往鼻部整形史(HR=2.89,95%,CI:2.08~3.97,P<0.001)、采用人工材料(HR=1.34,95%,CI:1.17~2.08,P=0.013)是功能性并发症发生的危险因素,外切口(HR=0.92,95%,CI:0.78~0.98,P=0.037)是保护因素。结论:隆鼻术中使用自体移植物和人工材料植入物均不能避免并发症,人工移植物有较高术后并发症。

Objective To investigate the effect of autologous cartilage and artificial material implants on the occurrence of postoperative complications during rhinoplasty.Methods This study included 447 patients who underwent cosmetic rhinoplasty at Hanmei Cosmetic Hospital in Dongguan.The age of enrolled patients was 18-52 years,and the mean age was 26.8±6.9 years.They were divided into an autologous cartilage group(334 patients in total)and an artificial material group(113 patients in total)according to the implant material used;the differences in postoperative complications were compared between the two groups and the influencing factors related to the occurrence of complications were analyzed.Results The follow-up time of all patients was 3-24 months,and the mean time was 19.4 months.51(11.4%)of the 447 patients developed postoperative complications during the follow-up period,and the rate of functional failure in the artificial material group(16.8%)was significantly higher than that in the autologous cartilage group(9.6%)(χ^(2)=4.17,P=0.037).In the autologous cartilage group,the most frequent complications were irregular nasal contour,a total of 10 cases(3.0%),and infection,8 cases(2.4%);while the most frequent complications in the artificial material group were infection,6 cases(5.3%)and prosthesis exposure,3 cases(2.7%).At 2-year follow-up,32 cases of the postoperative complication rate occurred(16.8%)in the autologous cartilage group,which was significantly higher than that of 19 cases(9.6%)in the artificial material group,and the difference between the two groups was statistically significant(log-rankχ^(2)=4.37,P=0.039).The results of the multifactorial COX risk factor analysis showed that history of smoking(HR=1.78,1.21-2.29,P=0.004),previous history of rhinoplasty(HR=2.89,2.08-3.97,P<0.001)and use of artificial materials(HR=1.34,1.17-2.08,P=0.013)and external incision(protective factor,HR=0.92,0.78-0.98,P=0.037)were independent risk factors for the development of functional complications.Conclusions Neither the use of autografts nor artificial implants in rhinoplasty prevents the occurrence of complications,and the types of complications occurring in both differ,with artificial grafts having a higher rate of postoperative complications.