小儿耳廓畸形无创矫正治疗效果研究

Study on the effect of non-invasive correction of infants with congenital auricular deformity

目的探讨小儿耳廓畸形无创矫正治疗效果及影响因素。方法回顾性分析2019年1月1日至2023年6月30日天津市天津医院耳鼻咽喉头颈外科门诊收治的使用国产外耳矫形器治疗的先天性耳廓畸形患儿资料。治疗前常规备皮,先安装矫形器底座并按压贴合耳周皮肤,之后根据耳廓畸形类型安装耳钩及耳盖,胶布固定。矫正治疗期间全天佩戴矫形器,矫正满意后观察1个月无明显反弹,则治疗结束。治疗期间密切观察并发症情况。治疗结束后评价治疗效果,分为显效、有效、无效,计算显效率(显效耳数/总耳数×100%)和有效率[(显效耳数+有效耳数)/总耳数×100%],同时记录显效患儿的治愈时间,并按照不同耳廓畸形类型及矫正初始年龄(<2、2~6、>6周龄)分组,进行相关指标的比较。使用SPSS 23.0软件进行统计学分析,计量资料用±s表示,多组间比较采用单因素方差分析,组间两两比较采用LSD法,计数资料用频数(%或者比值)表示,多组间比较采用χ2检验,组间两两比较采用调整α值的Fisher检验。结果共纳入31例患儿(55只耳),男13例(23耳),女18例(32只耳),出生后4至127 d;垂耳13只,环缩耳6只,杯状耳6只,猿耳4只,招风耳5只,耳轮畸形18只,耳甲腔横突畸形2只,Ⅱ度小耳畸形1只。治疗过程中5只耳出现皮损,5只耳出现轻度过敏反应,2只耳出现严重过敏反应,通过摘除矫正器晾晒后间断涂抹红霉素软膏后明显好转并继续治疗。经无创矫正治疗后患儿耳廓畸形均有不同程度改善,总体显效率为70.91%(39/55),总体有效率为90.91%(50/55),其中,垂耳、环缩耳、杯状耳、猿耳、招风耳、耳轮畸形、耳甲腔横突及Ⅱ度小耳畸形的显效率分别为13/13、4/6、4/6、4/4、4/5、8/18、2/2、0/1。39只显效耳的治愈时间为(36.08±14.77)d。不同耳廓畸形类型的治愈时间不同(P<0.01),组间两两比较显示,垂耳治愈时间较环缩耳、杯状耳、猿耳、招风耳短,招风耳治愈时间较垂耳、环缩耳、杯状耳、猿耳、耳轮畸形、耳甲腔横突长(P均<0.05)。剔除Ⅱ度小耳畸形1只,矫正初始年龄<2周龄组(12例,21只耳)、2~6周龄组(10例,18只耳)、>6周龄组(9例,15只耳)的显效率分别为90.5%(19/21)、13/18和7/15,差异有统计学意义(P<0.05),组间比较显示,<2周龄组显效率显著高于>6周龄组(P<0.017),但3组治愈时间差异无统计学意义(P>0.05)。结论小儿耳廓畸形无创矫正治疗效果显著。耳廓畸形类型是影响治疗效果及治愈时间的关键因素,垂耳、猿耳、招风耳和耳甲腔横突畸形的治疗效果好,其中,垂耳治愈时间较短,招风耳治愈时间较长,而环缩耳、杯状耳、耳轮畸形和Ⅱ度小耳畸形的治疗效果较差。初始矫正年龄越早,效果越好。

ObjectiveTo investigate the effect and influencing factors of non-invasive correction of infants with congenital auricular deformity.MethodsThe data of infants with congenital auricular deformity were retrospectively analyzed,who were treated with domestic external ear orthosis in the Department of Otolaryngology Head and Neck Surgery of Tianjin Hospital from January 1,2019 to June 30,2023.Before treatment,the skin was prepared routinely.First,the orthosis base was installed and pressed to fit the skin around the ear.Then,according to the type of auricle deformity,the ear hook and ear cover were installed,and the adhesive tape was fixed.During the corrective treatment,the orthosis was worn all day,and the treatment was ended if there was no obvious rebound after 1 month of observation.The complications were closely observed during treatment.After the treatment,the treatment effect was evaluated and divided into markedly effective,effective and ineffective.The markedly effective rate(markedly effective ears/total ears×100%)and effective rate[(markedly effective ears+effective ears)/total ears×100%]were calculated.At the same time,the cure time of the markedly effective children was recorded,and they were grouped according to different types of auricle deformities and the initial age of correction(<2,2-6,>6 weeks groups),and the related indicators were compared.SPSS 23.0 software was used for statistical analysis.The measurement data were expressed by Mean±SD.The comparison between multiple groups was analyzed by one-way ANOVA.The pairwise comparison between groups was performed by LSD method.The counting data was expressed by frequency(%or ratio).The comparison between multiple groups was performed byχ2 test,and the pairwise comparison between groups was performed by Fisher test with adjustedαvalue.ResultsA total of 31 cases(55 ears)were included,including 13 males(23 ears)and 18 females(32 ears),aged 4 to 127 d.There were 13 lop ears,6 constricted ears,6 cup ears,4 Stahl’s ears,5 prominent ears,18 helical rim deformity ears,2 conchal crus ears and 1Ⅱdegree microtia ear.During the treatment,5 ears had skin lesions,5 ears had mild allergic reactions,and 2 ears had severe allergic reactions,who improved significantly and continued treatment after removal of the external orthosis and use of erythromycin ointment.After noninvasive correction treatment,the auricle deformity of the children was improved to different extent.The overall markedly effective rate was 70.91%(39/55),and the overall effective rate was 90.91%(50/55).The markedly effective rate of lop ear,constricted ear,cup ear,Stahl’s ear,prominent ear,helical rim deformity ear,conchal ear andⅡdegree microtia ear were 13/13,4/6,4/6,4/4,4/5,8/18,2/2,0/1 respectively.The average cure time of 39 markedly effective ears was(36.08±14.77)d.The cure time of different auricle deformity types was statistically significant(P<0.01).Pairwise comparison between the groups showed that the cure time of lop ears was shorter than constricted ears,cup ears,Stahl’s ear,prominent ears,and that the cure time of prominent ears was longer than lop ears,constricted ears,cup ears,Stahl’s ears,helical rim deformity ears,conchal crus ears(all P<0.05).According to different initial ages of correction,the children were divided into<2-week-old group(12 cases,21 ears),2-6-week-old group(10 cases,18 ears),and>6-week-old group(9 cases,15 ears),excluding 1Ⅱdegree microtia ear.The markedly effective rates were(90.5%)19/21,13/18,and 7/15,respectively,with statistically significant differences(P<0.05).The comparison between groups showed that the markedly effective rate of<2-week-old group was significantly higher than that of>6-week-old group(P<0.017),but there was no statistically significant difference in the cure time among the three groups(P>0.05).ConclusionThe effect of non-invasive correction for congenital auricular deformity in infants is significant.The type of congenital auricular deformity is a key factor that affects the therapeutic effect and cure time.In lop ear,Stahl’s ear,prominent ear and conchal crus deformity,good therapeutic effects can be seen,but in constricted ear,cup ear,helical rim deformity ear andⅡdegree microtia,the effects are poor.The cure time of lop ear is short,while the cure time of prominent ear is long.The better effect can be acquired in the earlier non-invasive correction.