运用几何学原理评估改良Millard法对单侧Ⅲ度唇裂的修复效果

目的评估改良Millard法修复单侧Ⅲ度唇裂术后唇鼻畸形改善情况及其稳定性。方法选取自2018年10月至2020年7月就诊的单侧Ⅲ度唇裂患儿40例，采用改良Millard法进行唇裂修复。按照同一标准将患儿术前、术后1周及术后1年作为时间点进行照片采集。对所采集照片以同一标准进行坐标系的构建。健、患侧的鼻翼点(A)、鼻翼基部点(B)、唇峰点(C)及口角点(D)进行定位测量。计算各测量点坐标面积及对称率。比较各时间点健、患两侧面积差异；评估对称率随时间的整体变化情况；分析两两时间点之间的对称率变化情况，以评估手术改善情况及稳定性。结果健、患侧坐标面积之间比较，术前A、B、C、D点健、患侧差异较大(P < 0.01)。经改良Millard法手术修复，于术后1周时，A、C、D点差异仍有统计学意义(P < 0.01)，仅B点两侧差异无统计学意义(P>0.05)。术后1年时，A点两侧差异有统计学意义(P < 0.01)，但B、C、D点两侧差异无统计学意义(P>0.05)。在比较对称率的变化时发现，术后1周和术后1年各测量点对称率均高于术前(P < 0.01)，术后1年的A和D点的对称率高于术后1周(P < 0.01)。结论运用改良Millard法修复单侧Ⅲ度唇裂，唇鼻畸形改善明显，对称性改善较好且具有良好的稳定性。

Study on the effects of modified Millard′s method in the reconstruction of unilateral degree Ⅲ cleft lip evaluated by geometric principles

ObjectiveTo evaluate the improvement and stability of the modified Millard′s method in the reconstruction of lip-nasal deformity after unilateral degree Ⅲ cleft lip surgery.Methods Forty children with unilateral degree Ⅲ cleft lip treated with the modified Millard′s method from October 2018 to July 2020 were investigated.According to the same standard, the photos were collected before surgery, after 1 week and 1 year of operation.The coordinate system was constructed according to the same standard for the photos collected, the alar point(A), alar base point(B), lip peak point(C) and front cut point(D) of the healthy and affected sides were measured, and the coordinate area and symmetry rate of each measuring point were calculated.The difference analysis was made by comparing the area of healthy and affected sides at each time point, the overall change of symmetry rate over time was evaluated and the changes of symmetry rate between two time points were analyzed to assess the surgical improvement and stability.ResultsThe differences of the coordinate area at A, B, C and D points between the healthy side and affected side before operation were statistically significant(P < 0.01).After the modified Millard′s method surgery, the differences of the A, C and D points between the healthy side and affected side after 1 week of operation were statistically significant(P < 0.01), and the difference of which in B point was not statistically significant(P>0.05).After 1 year of operation, the difference of the coordinate area at A point between the healthy side and affected side was statistically significant(P < 0.01), but the differences of which at B, C and D points were not statistically significant(P>0.05).The symmetry rate of each measurement point after 1 week and 1 year of operation was higher than that before surgery(P < 0.01), and the symmetry rates of A and D points after 1 year of operation were higher than that after 1 week of operation(P < 0.01).ConclusionsThe modified Millard′s method in the reconstruction of unilateral degree Ⅲ cleft lip can significantly improve the lip-nasal deformity, and make the symmetry and stability better.