中国组织工程研究

中国组织工程研究

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体肋软骨移植修复创伤性鞍鼻畸形21例

陈  碾，邓  颖，李  明，曾  丽，谢红炬   

  1. 南华大学附属第一医院医疗美容科，湖南省衡阳市     421001
  • 出版日期:2010-04-30 发布日期:2010-04-30
  • 作者简介:陈 碾★，1973年生，湖南省衡阳市人，汉族，2003年南华大学医学院毕业，硕士，主治医师，主要从事颅颌面器官整形与修复研究。 chenniangood@126.com

Transplantation of autologous costal cartilage to repair post-traumatic saddle nose deformity in 21 cases

Chen Nian, Deng Ying, Li Ming, Zeng Li, Xie Hong-ju   

  1. Department of Plastic and Reconstructive Surgery, the First Affiliated Hospital of Nanhua University, Hengyang  421001, Hunan province, China
  • Online:2010-04-30 Published:2010-04-30
  • About author:Chen Nian★, Master, Attending physician, Department of Plastic and Reconstructive Surgery, the First Affiliated Hospital of Nanhua University, Hengyang 421001, Hunan province, China chenniangood@126.com

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摘要：

背景：外伤致鼻基本支架塌陷后，软组织也会塌陷收缩，另外外伤损伤鼻软骨会引起鼻软骨无菌性炎症从而致部分软骨吸收，所以长期的鞍鼻畸形常伴有鼻小柱过短。外伤性鞍鼻畸形合并鼻小柱过短用医用硅橡胶矫正时张力大，易出现皮肤穿孔、破溃等并发症。
目的：观察应用自体肋软骨移植修复创伤后鞍鼻畸形的效果。
方法：纳入21例外伤性鞍鼻伴鼻小柱过短患者，男6例，女15例，年龄16~45岁，均有明确外伤史，对治疗方案均知情同意。取自体右侧第7肋软骨塑形成柳叶形鼻梁模型假体，鼻小柱支架修复外伤后鞍鼻畸形。在鼻小柱底部人中凹陷处行“V-Y”皮瓣推进缝合以延长鼻小柱。观察自体肋软骨移植修复后患者鼻畸形恢复情况，移植软骨有无排出及切口瘢痕情况等。
结果与结论：自体肋软骨移植修复后患者鼻外形、鼻尖高度形态满意，鼻小柱延长，切口愈合良好，供软骨区无并发症发生。21例均获随访，随访时间6个月~2年，患者无移植软骨排出，无软骨变形，外形良好，鼻小柱底部人中凹陷处瘢痕小。提示应用自体肋软骨移植、人中凹陷处“V-Y”皮瓣推进缝合是修复创伤后鞍鼻畸形的理想方法。

关键词: 鞍鼻畸形, 外伤, 肋软骨, 移植, 修复, 组织移植

Abstract:

BACKGROUND: The soft tissues would shrink with nasal framework collapse following surgical trauma, which cause aseptic inflammation, lead to parts of cartilage resorption. Accordingly, long-term saddle nose deformity usually accompanied by short nasal columella. Complications such as skin perforation or ulceration would appear if corrected the deformity using medical silicone rubber with large tension.
OBJECTIVE: To explore the effectiveness of repairing post-traumatic saddle nose deformity with autologous costal cartilage transplantation.
METHODS: A total of 21 cases with post-traumatic saddle nose deformity accompanied by short nasal columella were selected, including 6 males and 15 females, aged 16-45 years. All of the cases had trauma history and agreed with the treatment. The costal cartilage was obtained from the seventh rib and formed to babylon weeping willow leaf shape and columella nasi stent to repair post-traumatic saddle nose deformity. The “V-Y” progradation suture was used in the philtrum introcession and the bottom of nasal columella to extend the nasal columella. The recovery of saddle nose deformity after transplantation, discharge of transplanted cartilage, as well as the incision scar status was observed.
RESULTS AND CONCLUSION: The results were satisfactory and there were no complications after transplantation. All the cases were followed up from 6 months to 2 years. No case suffered costal cartilage grafts discharge or chondral deformation. The scar was little at the bottom of nasal columella. It is an ideal method for repairing post-traumatic saddle nose deformity using transplantation of autologous costal cartilage with “V-Y” progradation suture.

中图分类号: 

3.2  病例中值得借鉴的经验   外伤性鞍鼻畸形合并鼻小柱过短用医用硅橡胶矫正时张力大，易出现皮肤穿孔、破溃的并发症[2] 。应用自体肋软骨移植修复外伤后鼻畸形是较为安全有效的[3] 。外伤性鞍鼻畸形矫正需要大量的软骨材料，选择肋软骨做为构建材料可以获得一个好而持久的治疗效果[4] 。软骨细胞不依靠直接的血液供给，而是主要靠体液营养，肋软骨量丰富，可塑性强，可按需取骨并雕刻成各种所需外形，吸收少，是最适合的隆鼻材料[5] 。肋软骨是自体组织，不发生排斥反应，质地适中，不会因鼻尖部皮肤的张力过大而顶破皮肤，因此可以放心的按美学标准重塑鼻尖[6] 。本组将所剩余软骨粉碎成一0.5~1 mm的小块，并装进1.0 mL的注射器中进行推注移植。用于填充肋软骨移植鼻成形术后遗留的空隙。软骨丁移植物的柔韧性好，在术中及术后调整方便，易于塑形[7] 。
注意事项：①切取肋软骨时应避免切穿胸膜。②软骨可发生自发性偏曲，雕刻软骨时背侧和腹侧削去的量应该相同，两侧削去的量也相同，这样雕出来的软骨假体发生卷曲的可能性才会降到最低[4]。也可在雕刻软骨时在上、下、两侧四个面做贯穿整个厚度2/3以上深的切口线，预防它的弯曲[5]。③雕刻鼻小柱支架时，肋软骨厚度以1.5~2.0 mm为宜，过薄支撑力不够且易弯曲变形[8] 。  
总之，作者认为，采用自体肋软骨移植修复创伤后鞍鼻畸形，鼻小柱底部人中凹陷处行“V-Y”皮瓣推进缝合以延长鼻小柱，手术效果肯定，术式简便易行，修复后并发症少。