鼻撑对不同单侧唇裂鼻畸形一期整复后软组织的临床研究

发布时间：2018-06-15 22:31

本文选题：唇裂 + 鼻畸形矫正　；参考：《山西医科大学》2017年硕士论文

【摘要】：目的:观察单侧完全性唇裂与单侧不完全性唇裂患儿行唇裂鼻畸形一期矫治术,统一采用Noordhoff唇裂术式,并在术后半年佩戴鼻撑矫治鼻畸形,研究鼻撑对不同唇裂鼻畸形一期整复术后半年鼻软组织形态恢复效果,为临床治疗不同唇裂鼻畸形提供参考并为术后二期鼻畸形整复提供有利条件[1-3]。方法:选取2012年1月-2016年10月就诊于山西医科大学第一医院3到6个月不同单侧唇裂患儿40例,男22例,女18例,平均年龄4.5±0.5个月。随机分为四个实验组,组一:单侧不完全性唇裂一期鼻畸形整复术+术后鼻撑矫治半年。组二:单侧不完全性唇裂一期鼻畸形整复术。组三:单侧完全性唇裂一期鼻畸形整复术+术后鼻撑矫治半年。组四:单侧完全性唇裂一期鼻畸形矫治术。对实验组患儿术后半年拍摄数码照片进行客观评价[4-6]。结果:通过测量鼻部软组织相关指标的非对称率与角度指标并应用Spss20.0软件进行统计分析后得出,四组差异有统计学意义[p〈0.05]。1、在组二与组四对比中发现,不同唇裂患儿在施行同一唇裂术式的情况下,单侧不完全性唇裂患儿在鼻孔高度、鼻孔宽度、鼻翼厚度、鼻翼突出距、鼻孔周长与面积的非对称率与单侧完全性唇裂患儿组相比,差异有统计学意义[p〈0.05]。鼻翼外展角,鼻小柱倾斜角,鼻底倾斜角较单侧完全性患儿组小,说明术后患儿鼻部形态的恢复与唇裂鼻畸形的程度相关。2、在组一与组二和组三与组四的对比中发现,同一分型的单侧唇裂患儿在相同术式条件下,佩戴鼻撑组患儿在鼻孔高度、鼻孔宽度、鼻翼厚度、鼻翼突出距的非对称率与对照组差异有统计学意义[p〈0.05]。鼻翼外展角,鼻小柱倾斜角,鼻底倾斜角较不佩戴组小,说明鼻撑在一期鼻畸形整复术后对鼻软组织形态的维持与恢复具有重要的临床意义,也为鼻畸形二期整复提供良好的手术条件。结论:不同单侧唇裂患儿在一期进行鼻畸形手术,术后通过积极佩戴鼻撑作为鼻畸形矫正术后的辅助性矫治措施,对于辅助及引导鼻正常生长发育具有重要的临床意义。同时为鼻畸形二期手术创造良好的条件,减少二期手术难度。
[Abstract]:Objective: to observe the primary correction of cleft lip nasal deformity in children with unilateral complete cleft lip and incomplete cleft lip, using Noordhoff cleft lip procedure and wearing nasal brace to correct nasal deformity half a year after operation. To study the effect of nasal bracing on the recovery of nasal soft tissue morphology half a year after primary repair of different cleft lip nose deformities, to provide references for clinical treatment of different cleft lip nose deformities and to provide favorable conditions for secondary nasal deformities after operation [1-3]. Methods: from January 2012 to October 2016, 40 children (22 males and 18 females) with different unilateral cleft lip were enrolled in the first Hospital of Shanxi Medical University from 3 to 6 months. The average age was 4.5 卤0.5 months. The patients were randomly divided into four experimental groups. Group 1: unilateral incomplete cleft lip one-stage nasal deformity was repaired for half a year after nasal bracing. Group 2: unilateral incomplete cleft lip one-stage nasal deformity. Group 3: unilateral complete cleft lip one-stage nasal deformities were repaired for half a year after nasal bracing. Group 4: unilateral complete cleft lip one-stage nasal deformity correction. Objective evaluation was made on the digital photographs taken half a year after operation in the experimental group [4-6]. Results: the asymmetry rate and angle index of nasal soft tissue were measured and analyzed by SPSS 20.0 software. The results showed that the difference among the four groups was statistically significant [p < 0.05] .1, which was found in the comparison of group two and group four. Under the same cleft lip operation mode, the patients with unilateral incomplete cleft lip had nostril height, nostril width, thickness of nasal wing, distance of nasal wing protrusion. The asymmetric rate of nostril circumference and area was significantly different from that of unilateral complete cleft lip group [p < 0.05]. The alar abduction angle, nasal column angle, and nasal floor angle were smaller than those in the unilateral complete group, indicating that the recovery of nasal morphology was related to the degree of cleft lip nasal deformity, which was found in the comparison between group 1 and group 2 and group 3 and group 4. In the same type of unilateral cleft lip, the asymmetric rate of nasal height, width, thickness of nasal wing and distance between the two groups were significantly different from those in the control group (p < 0.05). The alar abduction angle, nasal column angle, and nasal floor angle were smaller than those in the non-wearing group, which indicated that nasal bracing had important clinical significance for the maintenance and recovery of nasal soft tissue morphology after primary nasal deformity reduction. It also provides good surgical conditions for the second stage reduction of nasal deformity. Conclusion: children with different unilateral cleft lip underwent nasal deformity surgery in one stage. It is of great clinical significance to assist and guide the normal growth and development of nose by actively wearing nasal braces as auxiliary correction measures after nasal deformity correction. At the same time, good conditions were created for the second stage operation of nasal deformity and the difficulty of the second stage operation was reduced.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R782.21

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