鼻侧Medpor假体置入矫正鼻唇沟凹陷的临床效果观察

目的:探讨鼻侧Medpor假体置入矫正鼻唇沟凹陷、减轻法令纹的临床效果。方法:鼻唇沟凹陷、法令纹明显患者26例,采用鼻侧Medpor假体置入矫正鼻唇沟凹陷,术后评价矫正效果,记录不良反应。随访至手术后6个月。结果:所有受术者鼻唇沟凹陷矫正效果明显,法令纹减轻,患者对术后外观满意,无感染、血肿等并发症发生,随访6个月后,假体稳定,与骨贴合紧密,无移位、外露、变形,效果维持持久。结论:Medpor假体矫正鼻唇沟凹陷效果确切,改善法令纹满意,效果可以长期维持,值得临床推广。     

Medpor假体修复下颌角截骨术后下颌角部分缺失畸形

目的:不恰当的下颌角截骨术或者截骨过多会造成下颌角部分缺失畸形,本文选择了一组下颌角截骨术后下颌角部分缺失患者,来研究Medpor假体修复下颌角截骨术后下颌角部分缺失畸形的效果方法:选择本科室3年来5例下颌角截骨术后下颌角部分缺失患者,完善术前检查与分析。在全麻下应用Medpor假体矫治并用钛钉进行固定。术后观察治疗效果,并在6个月后对所有患者进行随访,调查患者满意度。结果:所有5例患者矫治后Ⅰ期愈合,所有患者两下颌角间宽度增加,侧面观下颌角线条自然清晰,恢复了下颌角的正常美学标准。6个月后随访,所有患者均对治疗效果表示满意结论:应用Medpor假体矫治并用钛钉进行固定,可有效地修复因下颌角截骨术后所造成的下颌角部分缺失,使患者下颌角达到一个理想的美学标准。     

鼻侧Medpor假体置入矫正单侧唇裂术后患侧上颌骨发育不足

目的：探讨鼻侧Medpor假体置入治疗单侧唇裂术后患侧上颌骨发育不足的疗效。方法：对2007年8月～2010年12月收治的16例单侧唇裂术后患侧上颌骨发育不足的患者,根据其解剖特点,选择Medpor假体置入来矫正患侧上颌骨发育不足,进行总结以评价其手术疗效。结果：术后随访所有患者3～6个月,切口瘢痕不明显,并发症少,患侧上颌骨发育不足得到矫正,患侧鼻翼塌陷畸形矫正良好,术后未见感染及假体外露。结论：畸形矫正的关键是以病理解剖为基础,最大程度地恢复其正常解剖位置及关系,鼻侧Medpor假体置入可以充分矫正唇裂术后患侧上颌骨发育不足,患侧鼻翼塌陷畸形得到矫正,效果稳定。     

Medpor联合鼻中隔软骨移植修复单侧唇裂鼻畸形

目的利用Medpor联合鼻中隔软骨移植修复单侧唇裂鼻畸形。方法利用Medpor假体垫于患侧梨状孔边缘,以抬高鼻基底;切取鼻中隔软骨,用以抬高鼻尖和修复塌陷的鼻翼。结果15例患者鼻畸形得到明显改善,外形基本接近正常。结论Medpor联合鼻中隔软骨移植能较大程度地改善单侧唇裂继发的鼻畸形,值得临床推广应用。     

重度外伤性鞍鼻畸形的个性化硅胶假体填充治疗

目的:探讨个性化硅胶假体在重度外伤性鞍鼻畸形治疗中的应用。方法:根据每位患者受伤程度,以整块硅橡胶为材料,雕刻适合每一位患者的鼻部填充假体,术中于鼻骨表面分离假体置入腔隙,置入假体。结果:6例患者进行个性化硅胶假体填充治疗后,均取得良好效果,术后随访3个月~2年,无并发症发生。结论:个性化硅胶假体填充生物相容性好、适合雕刻、材料充足、经济实用,仍然是目前治疗重度鞍鼻畸形的理想方法之一。     

Medpor支架植入耳廓再造术围术期的护理

目的 总结Medpor支架植入耳廓再造手术患者囤术期护理经验,以不断提高护理质量.方法 对50例小耳畸形综合征患者行Medpor支架植入耳廓再造术;术前做好心理护理和术前准备,术后做好麻醉、饮食、负压引流、再造耳、并发症的护理及出院指导.结果 48例外耳再造成活,形态基本满意.另2例中1例右耳一期植入Medpor支架术后因外力导致切口裂开,支架外露;1例左耳一期植入Medpor术后2个月耳轮近三角窝处Medpor支架外露;均经再次手术治疗后恢复.结论 小耳畸形综合征患者行Medpor支架植入耳廓再造术效果较好,针对性的护理是手术获得良好效果的保证.     

多孔高密度聚乙烯在颅面凹陷畸形综合修复中的应用

目的 探讨多孔高密度聚乙烯(Medpor)在颅面部凹陷畸形综合修复中的应用效果.方法 对先天性或外伤后颅面部凹陷及缺损畸形37例应用Medpor结合其他措施进行综合修复.其中外伤性凹陷畸形29例,进行性半侧颜面萎缩6例,下颌角发育不良2例,通过观察并发症发生情况和满意度调查,确定Medpor在颅面凹陷畸形综合修复中的应用效果.结果 临床随访3个月至4年,患者术后外形良好,无自觉不适症状,无感染、排异等并发症,置人物稳定,均满意或比较满意.结论 Medpor是颅面骨性凹陷性畸形修复的较理想填充材料,结合其他方法可以使面部轮廓得以改善,获得良好的治疗效果.     

双侧Medpor置入矫正鼻旁区凹陷畸形

目的：探讨应用高密度多孔聚乙烯（Medpor）置入矫正鼻旁区凹陷畸形方法。方法：对17例先天鼻旁区凹陷患者以Medpor作为置入材料,在凹陷区下方骨质表面贴附充填。结果：17例患者鼻旁区凹陷得以矫正,外形效果满意,无感染、假体外露等并发症。结论：Medpor置入矫正鼻旁区凹陷畸形,是一种安全有效的方法。     

颗粒脂肪移植在伴有双颌前突的鼻颏美容整形中美学形态掩饰的实现

目的探讨以应用自体肋软骨移植矫正鼻畸形为核心,联合自体颗粒脂肪行面部填充术+假体隆颏术,矫正视觉上骨性双颌前突面部畸形的效果。方法对11例确诊面部骨性双颌前突畸形的患者采用3项手术联合的方案进行面部畸形矫正,即自体肋软骨鼻畸形矫正术、颗粒脂肪面部填充和假体隆颏术。切取左侧第7肋软骨矫正鼻畸形,增加鼻背高度和鼻尖突出度;取大腿外侧皮下自体脂肪纯化离心后,填充矫正面部凹陷;硅胶假体填充下颏矫正颏后缩。结果本组11例患者获术后随访6～18个月,所有患者的骨性双颌前突的缺陷在视觉上均获得了矫正,同时鼻畸形及下颏后缩也得到明显改善,获得了较和谐的鼻、唇、颏之间的关系,面部整体美观协调性得到了较大的提升。患者对效果均较满意。结论以应用自体肋软骨矫正鼻畸形为核心的面部轮廓调整,联合自体颗粒脂肪面部填充术+假体隆颏术,可以在视觉上显著改善骨性双颌前突,实现新的面貌美学平衡,效果可靠,具有一定的临床应用价值,为改善骨性双颌前突的面部畸形提供了一种新思路。     

颜面部凹陷畸形的整复治疗

引起颜面部凹陷畸形的原因很多 ,可分为骨性凹陷和软组织凹陷畸形。笔者 1986年 6月至 2 0 0 0年 6月间采用陈旧性骨折复位内固定 ,自体骨移植 ,自体骨移植 人工骨填充术 ,膨体聚四氟乙烯 (ｅＰＴＦＥ)植入及自体脂肪颗粒注射移植等方法整复颜面部骨性凹陷畸形和软组织凹陷畸形共 5 8例 ,收到较好效果 ,报道如下。1　临床资料　1.1　一般资料　本组 5 8例中 ,男 2 6例 ,女 32例。年龄 11～4 3岁。本组骨性凹陷畸形 2 3例 ,其中上颌骨、颧骨多发性陈旧性骨折凹陷畸形 4例 ,外伤性前额、颞部及眶周凹陷畸形 9例 ,外伤性鼻骨骨折鞍鼻畸形 2例 …     

自体软骨及高密度多孔聚乙烯材料在鼻整形中的应用

目的探讨自体软骨联合高密度多孔聚乙烯（Medpor）在鼻整形中应用的方法和疗效。方法根据具体情况,选择Medpor作为填充物进行鼻小柱延长,自体软骨作为鼻尖覆盖,自体软骨连接并延长鼻中隔,联合鼻背部填充自体软骨或假体隆鼻,对65例鼻美容求美者进行综合整复。结果本组共65例求美者,术后随访6～12个月,鼻小柱延长及鼻唇夹角减少效果明显,鼻背形态自然,无感染、假体外露等并发症。结论自体软骨与Medpor联合置人是安全、有效的鼻整形方法,尤其对于鼻尖、鼻小柱的处理,可提升整体手术的效果。     

Porous Polyethylene Implants for Nasal Reconstruction: Clinical and Histologic Studies

This paper describes a technique of using Medpor porous high-density polyethylene implants for nasal reconstruction and chin augmentation. This biocompatible material has been used successfully during the last decade for various applications in the reconstruction of the facial skeleton. Among its most frequent uses are repair of the orbital floor and reconstruction of the burned ear, which became standard methods at many centers. Relatively little experience is, at present, on hand concerning the use of porous polyethylene in reconstruction of the nasal framework. Twenty-three consecutive, difficult nasal reconstructions were performed using this method since 1996. Patients were followed up for from 1 to 3 years (mean, 2 years). The results were durable and stable over the time. Eight patients had saddle nose deformity and 15 had catastrophe noses, mostly referrals, previously operated on from one to four times. My aesthetic goals were correction of the depressed nasal dorsum, creation of an acceptable nasal dorsum in the thick and/or twisted noses, and tip elevation. For nasal applications Medpor is available as a strut or sheet. Its body, once implanted, becomes rapidly vascularized and both soft tissue ingrowth and collagen deposition occur. This was confirmed by the microscopic investigation of biopsies. One patient of Vietnamese origin had an aesthetically pleasing result, but her family refused to accept her westernized nose. This gave me a unique opportunity to study the whole Medpor implant 6 months after implantation. There were two complications, one small implant exposure and one low-virulent infection involving the nasal tip. Following revision and antibiotic treatment, both patients healed without sequel. All reconstructions were successful in restoring nasal aesthetics and function. Four patients underwent chin augmentations with an uneventful clinical course.     

自体耳软骨联合膨体聚四氟乙烯矫正短鼻畸形

目的：介绍一种矫正先天性短鼻畸形的手术方法一自体耳软骨联合膨体聚四氟乙烯（expanded polytetrafluethlene,ePTFE）,对先天性短鼻畸形患者行鼻部延长及鼻尖成形术。方法：采用闭合式切口,钝性分离鼻背筋膜后间隙至合适范围,充分松解鼻翼软骨处连接韧带,根据患者自身要求雕好鼻假体,耳屏软骨固定于假体小柱端成“L”形,耳甲腔软骨置于鼻尖处,缝合固定双侧鼻翼软骨肉侧角于“L”形植入体短臂上。结论：对145例患者随访1～2年,鼻延长长度为5～11mm,平均为9mm,伴有鼻尖低平者,鼻尖突出度增加3～7mm,平均5mm,均获得满意效果。结论：采用自体耳甲腔软骨及耳屏软骨联合ePTFE可以有效延长鼻长度,疗效可靠,可作为矫正先天性短鼻畸形的方法之一。     

开放式手术矫正陈旧性外伤性歪鼻畸形

目的总结治疗外伤性歪鼻畸形的经验，掌握正确的歪鼻矫正技术，提高临床治疗效果。方法1996年12月至2004年2月，采用开放式手术，完全显露歪曲的结构，松解外在及内在牵拉力量，复位鼻骨、矫直鼻中隔使其解剖复位，重塑鼻支架。结果本组患者36例，术后随访4个月至5年，优31例，良5例。鼻畸形获得满意的矫正，鼻外形恢复良好。结论外伤性歪鼻畸形多因伤后早期未获得及时有效地处理所致，经开放式手术复位鼻骨、矫直鼻中隔及鼻部整形术，消除引起畸形的原因，可取得较满意的效果。     

开放式唇裂继发鼻畸形整形术

目的：探讨单侧唇裂继发鼻畸形的手术治疗。方法：应用跨鼻小柱的鼻翼软骨下缘切口开放式鼻整形进行唇裂继发鼻畸形矫正,鼻小柱侧缘切口继续向下延伸至鼻小柱基底,将鼻小柱基部皮肤向下翻开,充分松解和暴露鼻翼软骨,矫正中隔畸形,将鼻翼软骨向前上内侧复位,与健侧鼻翼软骨、鼻背侧软骨缝合固定,必要时进行切取鼻中隔软骨移植以抬高鼻尖以及加强鼻穹窿。结果：应用本方法治疗单侧唇裂继发鼻畸形47例,单纯进行鼻畸形矫正者11例,同时行唇畸形整形者36例,效果满意,其中有32例进行了6～24个月的随访,平均随访时间为11个月,鼻外形良好。结论：应用开放式鼻整形技术进行唇裂继发鼻畸形矫正,可在直视下充分松解并显露鼻翼软骨,准确复位及缝合固定,术后效果稳定,切口无明显瘢痕。     

中国汉族青年女性鼻尖活动度的测量及临床意义

目的调查中国汉族青年女性的鼻尖活动范围，并与隆鼻受术者的鼻尖活动范围对比，完善我国外鼻测量内容．为鼻整形提供形态学资料及术后评判指标。方法选用100名普通青年女性和30名植入人工材料的隆鼻术后女性的外鼻，确定鼻的活动临界点A，测量鼻尖活动度（左、右）、A点至鼻尖距离（A—P）和鼻长。结果中国正常汉族青年女性鼻尖活动度35．73°±4．72°．隆鼻后鼻尖活动度22.45°±7．53°．两者有明显统计学差异。正常青年女性的A—P间距为（16．62±1．95）mm，隆鼻后为（25．89±10．16）mm。鼻长均在正常范围内。调查发现受术组中有63％感知鼻尖活动度下降，30％因此对手术效果欠满意。27％术后不会当众碰触鼻端，7％对此十分在意。结论应用直接测量法为鼻整形提供有参考价值的鼻尖活动度的正常值，并证实植入人工材料的隆鼻术降低鼻尖活动度，进而影响受术者对手术效果的评价。     

Porous high-density polyethylene implants (Medpor) for nasal dorsum augmentation

Background: As rhinoplasty techniques are refined, the search for a permanent augmentation material continues. Use of autologous material creates a donor site deformity, and the material may be phagocytized over a period of time. Use of alloplastic materials often results in extrusion and infection. Objective: The purpose of this study was to examine the results of nasal augmentation using porous high-density polyethylene implants. Methods: A Medpor porous high-density polyethylene implant is carved to the approximate desired size and contour. A pocket is made in the dorsum, and sometimes over the caudal border of the septum, to accommodate the dimensions of the implant. The implant is fitted, removed, trimmed, and refitted until the precise desired contour and position are attained. The implant is rinsed in antibiotic solution and placed in position. The mucosal surfaces are closed with absorbable sutures. Results: Over the last 12 years, this technique has been used with satisfactory results in more than 30 patients. Two implants were subsequently removed because of partial implant exposure and possible infection. There were no other significant complications. Four typical cases are presented with up to 12 years of follow-up. Conclusions: When substantial strength is needed, porous high-density polyethylene implants may be used for dorsal augmentation or correction of dorsal defects with satisfactory long-term results and limited complications.     

Clinical experience with the medpor porous polyethylene implant

The Medpor porous polyethylene implant is a highly stable and somewhat flexible porous alloplast that has been shown to exhibit rapid tissue ingrowth into its pores. A total of 116 Medpor implants were placed in 70 patients over a four-year period. Implants were used for the chin, malar area, nasal reconstruction, ear reconstruction, orbital reconstruction, and the correction of craniofacial contour deformities. Many of these implants were placed in areas long considered problematic such as areas of thin soft tissue coverage, extensive scarring, and severe facial burns. Nine complications occurred including seven exposures, all of which occurred in areas of minimal soft tissue coverage. Because of the rapid vascularization of the implants, only two implants were removed, both from the columella. On the basis of our results, it is felt that the Medpor implant is an excellent alternative to existing implant materials. The implant is easy to shape; it is strong yet somewhat flexible; it is remarkably stable; and it exhibits tissue ingrowth into its pores.     

多孔高密度聚乙烯置入联合耳甲软骨移植鼻尖成形术

目的探讨多孔高密度聚乙烯（poroushigh-density polyethylene，Medpor）置入联合自体耳甲软骨移植行鼻尖成形术的操作方法及适应证。方法采用8．5mm厚的Medpor薄片置入支撑鼻尖，并联合应用自体耳甲软骨移植以优化鼻尖形态。结果36例术后鼻尖部形态良好，无感染、置入体外露等并发症发生。结论Medpor能为鼻尖部提供强有力的支撑，安全、有效，适应于纠正鼻尖部上旋、抬高和延长鼻尖部的成形术，联合自体耳甲软骨移植可进一步提高鼻外形效果。