摘要
目的探讨不对称切削技术雕刻拼接肋软骨支架存改善耳再造临床效果中的作用。方法回顾性分析2013年6月至2015年12月间，应用传统肋软骨雕刻方法（平衡切削法）和不对称切削雕刻拼接技术（不对称切削法）治疗的35例病例，分为A组和B组进行对照研究。其中A组19例，B组16例。通过对比2组支架雕刻时间、术后再造耳的外观情况（评价指标包括精细结构显现的清晰度、形状、大小、局部皮瓣颜色及凸出度），以及2组手术并发症的情况，探讨不对称切削法在耳再造术中的有效性及安全性。结果2组支架雕刻时间均约为40min左右，差异无统计学意义。外观情况方面，B组病例术后再造耳精细程度、形状、大小、颜色及凸出度方面平均值均优于A组，除大小方面，其余几项的差异均具有统计学意义。并发症情况比较，A组皮片部分坏死2例，并伴有软骨外露，其中1例继发软骨部分坏死，经积极处理后病情得以控制，局部皮瓣转移治疗后治愈，其余病例未出现明显的支架变形、扭曲、塌陷；B组未发生皮片坏死、软骨外露、感染、支架扭曲、变形、塌陷等并发症。结论2种雕刻方式的支架均安全、可靠。不对称切削法不会增加支架雕刻时间。在外观情况方面，不对称切削法明显优于平衡切削法。
Objective To explore the application of asymmetrical sculpture in the ear reconstruction with autologous cartilage through comparing the difference of the balanced sculpture and asymmetrical sculpture. Methods We used the method of retrospective survey and classified the patients who had undergone ear reconstruction because of microtia into two groups. Group A included the patients who had undergone operation with the application of balanced sculpture method. Group B included the patients who had undergone operation with the application of unsymmetrical sculpture method. We picked out 35 patients containing 19 patients of group A and 16 patients of group B according to our grouping criteria and exclusion criteria. The number of cases with complications was recorded, such as collapse of fi＇amework, exposure of cartilage, necrosis of skin flap and reconstructed ear infection. The clinical outcomes of two methods in refining the delicate structures of the reconstructed ear were evaluated （that is the definition, shape, size, color and projection）. The time for sculpture was compared. Then we analysed the results and evaluated the effectiveness, safety and feasibility of asymmetrical sculpture＇s application in the ear reconstruction. Results Group A had 2 cases which suffered skin flap necrosis. One of them had cartilage exposure and then had secondary infection leading to local cartilage necrosis and absorption, but after active treatment and local skin flap transplantation it was cured. Group B had no skin flap necrosis,cartilage extrusion, framework deformation and distortion, framework collapse and necrosis or absorption. Group B had a higher score in definition, shape, size, color and projection, and the difference was significant in definition, shape, color and projection. In our clinical practice, the sculpture time in both group was similarly about 40 minutes after the surgery operator had skillfully mastered both techniques. Conclusions Both methods are safe and feasible. The method of asymmetrical sculpture does not require additional operative time, and the method of asymmetrical sculpture is a better one compared with the method of balanced sculpture in refining the reconstructed ear.
作者
赵静霞
唐鸿波
吴敏
曹玮
余晶
邓裴
Zhao Jingxia;Tang Hongbo;Wu Min;Cao Wei;Yu Jing;Deng Pei(Department of Plastic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Chin)
出处
《中华整形外科杂志》
CAS
CSCD
北大核心
2018年第3期188-192,共5页
Chinese Journal of Plastic Surgery
关键词
小耳畸形
耳廓再造术
肋软骨
切削
不对称
Mierotia
Reconstruction of auricle
Costal cartilage, cutting
Asymmetry
