鼻内镜下复合鼻外伤的整形美容修复

目的探讨鼻内镜下复合鼻外伤整形美容I期修复的方法与疗效。方法选取54例外伤在1个月之内,结合体征及鼻骨CT扫描,确诊为复合鼻外伤的患者。通过鼻骨三维重建CT扫描及术中所见,分析外伤部位。然后于鼻内镜下采取综合方法,治疗鼻中隔偏曲,手术中尽量保留骨与软骨,以维护鼻中隔的支架结构,治疗鼻中隔偏曲。鼻内镜下经鼻中隔黏膜囊入路行鼻骨复位术,在鼻骨骨折的底表面明视下将骨折复位。结果外鼻支架双侧骨折占92．59％（50／54）,鼻中隔软骨损伤占92．59％（50／54）,筛骨垂直板骨折占70．37％（38154）,犁骨偏曲骨折占22．22％（12／54）。鼻内镜下鼻中隔整形术方式有：软骨推移42．59％（23／54）,“井”字划痕24．07％（13／54）,条状切除38．89％（21／54）,骨折移位61．11％（33／54）,骨部分切除31．48％（17／54）。54例中,显效90．74％（49／54）,好转9．26％（5／54）。结论鼻内镜下鼻中隔偏曲整形术联合经鼻中隔剥离黏膜囊入路鼻骨复位整形美容术,疗效好,能同时解决外形与功能的问题。

Morphologic and functional correction of complex nasal injury under endoscopy

Objective To investigate the methods and results of first-stage reconstruction of morphologic and functional correction for complex nasal injury under endoscopy. Methods 54 patients all were diagnosed as complex nasal injury within 1 month trauma-period according to their history, sign and CT scan towards nasal bone. The injured locations were analyzed by 3D CT images and find- ings during the operations. To remedy the deviation of nasal septum, endoscopic nasal septum recon- structions were performed accordingly. The methods of surgery were varied according to different trauma conditions and locations, while mostly were reconstruction type. The bones and cartilages were kept as far as possible to maintain the trestle structure of septum. In addition, the nasal bones were replaced in endoscopic vision per nasal septum process. Results The fracture rate of bilateral nasal bone braces was 92.59 % （50/54）, septum cartilage was 92.59 % （50/54）, ethmoid bone （lamina perpendicularis） was 70.37 % （38/54）, and vomer deviation was 22.22 % （12/54）. The methods of nasal septum reconstruction under endoscope included cartilage pushing： 42. 59 % （23/54）, ＂ #＂ shape rupture： 24.07%（13/54）, part cartilage resection： 38.89 % （21/54）, bone fracture shift： 61.11 %（33/54） and part bone resection： 31.48 %（17/54）. In our 54 cases of patients, the rate of excellent effectiveness was 90.74 % （49/54）, partial effectiveness was 9.26 % （5/54）. All patients had improvement both in morphology and function. Conclusions Endoscopic nasal septum and nasal bones reconstruction per nasal septum incision is effective in resolving both morphologic and functional problems.