自体软骨在外伤性歪鼻合并鼻通气障碍患者鼻整形术中的应用探讨

目的探讨自体软骨在外伤性歪鼻合并鼻通气功障碍患者鼻整形术中的使用方法和效果。方法回顾性分析2017年1月至2019年4月,在陆军军医大学大坪医院耳鼻咽喉头颈外科收治的30例鼻外伤患者的病例资料,其中男21例,女9例,年龄21~50岁,平均34.9岁,病程6 d至14年。全部患者均伴有不同程度的歪鼻畸形及鼻通气障碍,分为轻、中、重三类,其中轻度8例,中度11例,重度11例,均同期行开放性鼻整形术及鼻中隔偏曲矫正术。对于轻、中度歪鼻畸形及鼻通气障碍,采用耳软骨修饰鼻尖及加强鼻中隔软骨支撑、修饰鼻背凹陷畸形。对于重度歪鼻畸形及鼻通气障碍,将肋软骨雕刻成"Y"字型整体支架或者片状肋软骨构成2+1或4+1支架,将肋软骨支架与鼻中隔软骨尾端贯穿缝合固定,重塑加固鼻中隔支撑架及鼻小柱,避免鼻背塌陷。术前、术后测量鼻外观偏离值,并分别进行鼻外观视觉评分量表(VAS)、鼻腔通气VAS评分。采用Stata 15统计软件对术前与术后的测量数据行配对资料的t检验,VAS评分行卡方检验。结果30例患者中,3例术后出现鼻中隔血肿,经清理后正常恢复。术后随访2个月至2年,所有患者均无鼻中隔穿孔、鼻梁塌陷等并发症发生。术后治愈率为60.0%(18/30),所有患者术后歪鼻程度下降Ⅰ级,有效率为100%(30/30)。患者术后测量鼻外观偏离值低于术前,差异有统计学意义(2.40±1.58)mm比(6.85±2.43)mm,t=8.42,P<0.001]。术后鼻外观VAS评分高于术前,差异有统计学意义(6.60±1.16)分比(1.93±1.31)分,t=-14.59,P<0.001]。患者术后鼻腔通气VAS评分高于术前,差异有统计学意义(6.53±1.04)分比(1.97±1.07)分,t=-16.78,P<0.001]。结论自体软骨在外伤性歪鼻合并鼻通气功障碍患者鼻整形术中使用疗效好,同期行开放性鼻整形术及鼻中隔偏曲矫正手术,可缩短治疗时间,及时改善患者鼻外观及鼻通气功能。

Application of autologous cartilage in rhinoplasty for patients with traumatic nasal contraction and nasal dysfunction

Objective To explore the application and effect of autologous cartilage in rhinoplasty for patients with traumatic hernia and nasal dysfunction.Methods From January 2017 to April 2019,30 patients with nasal trauma admitted to Department of Otorhinolaryngology Head and Neck Surgery,Daping Hospital,Army Medical University were treated for 6 days to 14 years.All patients were accompanied by different degrees of nasal deformity and nasal ventilatory disorders.They were classified into three categories:light,medium and heavy.All of them were open at the same time.Rhinoplasty and nasal septum deviation correction.For mild to moderate nasal deformity and nasal ventilatory disorders,ear cartilage was used to modify the tip of the nose and strengthen the nasal septal cartilage support to modify the deformity of the nasal back.For severe nasal deformity and nasal ventilatory disorders,we engraved the costal cartilage into a"Y"shaped monolithic stent or flank costal cartilage to form a 2+1 or 4+1 stent,and the costal cartilage stent and the septal cartilage tail end were sutured.Reshape the nasal septum frame support and the nasal column to avoid collapse of the nose.Results Three patients had a septal hematoma after operation and recovered normally after cleansing.All patients were followed up for 2 months to 2 years,and no complications such as nasal septum perforation and nasal bridge collapse occurred.The postoperative cure rate was 60.0%(18/30).All patients had a grade I nasal drop after surgery,and the effective rate was 100%(30/30).The patient′s preoperative measurement deviation was(6.85±2.43)mm,the postoperative measurement deviation was(2.4±1.58)mm,the preoperative nasal appearance VAS score was(1.93±1.31),and the postoperative nasal appearance VAS score was(6.60±1.16),the difference in facial appearance deviation and VAS score before and after surgery was statistically significant(P<0.05).All patients had improved nasal ventilation after operation.The preoperative nasal ventilation VAS score was(1.97±1.07),the postoperative nasal ventilation VAS score was(6.53±1.04),and the difference between preoperative and postoperative nasal ventilation VAS scores was statistically significant(P<0.05).Conclusions Autologous cartilage is effective in rhinoplasty in patients with traumatic nasal contraction and nasal dysfunction.One stage open rhinoplasty and nasal septum deviation surgery are performed to shorten the treatment time and improve the nasal appearance and nasal ventilation function.The patients got satisfaction.