三种全耳再造手术方式支架外露情况的比较研究

目的:通过比较三种不同全耳再造手术方式术后支架外露的发生情况,为耳再造手术方式的选择提供依据。方法:对369例全耳再造术分别采用耳后乳突区皮肤扩张后肋软骨支架耳再造(软骨组)、颞浅筋膜瓣翻转Medpor材料耳再造(Medpor组)及颞浅筋膜瓣翻转肋软骨耳轮联合Medpor耳基耳再造手术(复合组),比较不同全耳再造术后支架外露的发生率、发生部位、出现时间及与患者年龄、手术时期等方面的差异。结果:软骨组、Medpor组及复合组支架外露发生率分别为7.1%、12.9%及6.7%,三者比较差异无统计学意义(P>0.05)。三组中,耳轮外上缘均为外露比例最高部位,出现时间均多在术后3月内发生。软骨组支架外露发生率在18岁以上者最高,Medpor组支架外露发生率则在18岁以上者最低(P<0.05)。近5年来手术者支架外露比例较前5年降低。结论:不论选择何种手术方式,均不能完全杜绝支架外露的发生,采用何种方法要依患者的情况及术者对手术方式的掌握情况来综合考虑。但对于6～12岁少儿,采用肋软骨法再造为宜;而对于大于18岁的成人,则采用Medpor法再造为宜。

Investigation of the framework exposure following three kinds of ear reconstruction

Objective To provide the basis for operation choice of ear reconstruction by comparing the occurrence of the framework exposure following three kinds of ear reconstruction.Methods 369 cases of ear reconstruction were performed with three operation methods: expanded skin flap on the mastoid region covering costal cartilage framework(cartilage group),superficial temporal fiscia flap covering Medpor framework(Medpor group) and superficial temporal fiscia flap covering costal cartilage helix and Medpor base compound framework(compound group).The differences of the incidence,occurring place,appearance time,age of patients and operation period of the framework exposure in diverse operation methods were compared.Results The incidence of framework exposure of cartilage group,Medpor group and compound group was 7.1%,12.9% and 6.7% respectively.There were no statistical differences among three groups(P>0.05).The framework exposure occurred mostly in the extra-superior margin of the helix,and was mostly found within three month after ear reconstruction in all three groups.The incidence of framework exposure in cartilage group was the highest in 18 years or older,as well as the incidence in Medpor group was the lowest in 18 years or older(P<0.05).The proportion of framework exposure in recent five years was decreased compared to five years before.Conclusion No matter which operation method can completely eliminate the occurrence of framework exposure.The selection of operation methods is determined by the conditions of the patients and the mastering degree of the operators of the methods.We suggest that the cartilage framework reconstruction is suitable for 6 to 12 years old children,and the Medpor framework reconstruction is suitable for adults over 18 years old.