封闭肋软骨膜对软骨修复再生影响的研究

发布时间：2018-12-12 18:43

【摘要】：背景小耳畸形是较常见的耳廓先天性发育不良,常伴有外耳道闭锁、中耳畸形、颌面部畸形以及其他系统器官畸形,在颌面部先天畸形中仅次于唇腭裂的发病率。耳廓再造手术仍是目前最有效的治疗方法。自体肋软骨由于其良好的组织相容性、无排异反应、易于获取、较好的抗压能力等优点已成为公认的最佳的再造支架来源。但是由于软骨的再生能力较差,切取大量肋软骨会破坏胸廓结构的完整性,降低胸廓的稳定性,耳再造术又多在青少年时期进行,随生长发育,可能会导致胸廓畸形和反常呼吸。目前已经有越来越多的学者关注到了此问题,并对其做了大量研究以期减少术后胸廓畸形的发生。部分学者提出了术中切取肋软骨同时保留软骨膜和骨-软骨连接处(CCJ)等,这些方法都已经被证实是可以有效促进纤维组织生长的。也有学者提出切取肋软骨进行雕刻后将剩余的软骨碎屑再次回植于软骨膜内,并进行了实验研究,然而其具体机制及效果目前尚未明确,亦缺乏临床研究数据。另有医生提出将肋软骨碎屑中加入生物材料一并回植于切取软骨后的供区软骨膜内,此种方法仅为动物实验,尚未能应用于临床工作之中。本实验拟运用三维CT重建技术收集影像学资料,分析耳廓再造术中切取肋软骨后封闭软骨膜对肋软骨、纤维组织修复再生及胸廓发育的影响。目的以先天小耳畸形患者为研究对象,采用改良的Nagata二期耳廓再造法行手术治疗,术中切取肋软骨作为再造耳支架材料,运用三维CT重建技术,重建术后肋软骨及再生物形态,分别在长度、宽度、弧度、倾斜度等方面与术前进行对比,观察耳廓再造术中切取肋软骨后缝合软骨膜与否对肋软骨的生长及远期胸廓形态发育的影响。方法收集2014年6月~2016年10月于河南省人民医院整形美容外科收治的先天性小耳畸形患者36例,所有患者均采用改良的Nagata二期法行全耳再造术。术中封闭肋软骨膜26例,未封闭肋软骨膜10例,每例患者分别于一期术前、二期术前一周内行“胸廓CT平扫+肋软骨三维重建”,对比分析两组患者间组织再生的情况。结果封闭组共26例,均可见再生组织(100%),肋软骨再生者3例(11.5%),纤维组织钙化者23例(88.5%),形态、走形与术前肋软骨基本一致,胸廓均保持良好形态,未见明显凹陷和成角畸形。未封闭组共10例,见再生组织者2例(20%),均为纤维组织钙化。两组相比较差异具有统计学意义(P0.05)。结论耳廓再造术中尽可能的保留肋软骨膜的完整性,并将其封闭为管套状结构有利于软骨及纤维组织的再生,降低术后胸廓畸形的发生率;切取肋软骨后胸廓畸形的发生率随年龄增长逐渐下降。
[Abstract]:Background microauricular malformation is a common congenital dysplasia of auricle, often accompanied by atresia of external auditory meatus, middle ear malformation, maxillofacial malformation and other system organ malformations, which is second only to cleft lip and palate in congenital malformation of maxillofacial region. Auricle reconstruction is still the most effective treatment. Due to its good histocompatibility, no rejection, easy to obtain, and good compression resistance, autogenous costal cartilage has been recognized as the best source of scaffolds. However, because of the poor regeneration ability of cartilage, the removal of a large amount of costal cartilage will destroy the integrity of the thoracic structure and reduce the stability of the thorax. It can lead to deformity of the chest and abnormal breathing. At present, more and more scholars have paid attention to this problem, and have done a lot of research on it to reduce the incidence of postoperative thoracic deformity. Some scholars have proposed that the removal of costal cartilage while preserving the chondromatum and osteochondral junction (CCJ) and so on. These methods have been proved to be effective in promoting the growth of fibrous tissue. Some scholars have also proposed that the residual chondroclasts should be implanted back into the chondrocytes after the costal cartilage was cut and engraved, and the experimental study was carried out. However, the mechanism and effect of this method are not clear, and the clinical data are lacking. Other doctors proposed to add biomaterials into the donor chondrocytes after cartilage removal. This method is only an animal experiment and can not be applied in clinical work. Three dimensional CT reconstruction was used to collect the imaging data and to analyze the effect of removing costal cartilage and blocking chondrocytes on the regeneration of costal cartilage, fibrous tissue repair and thoracic development in auricle reconstruction. Objective to study the patients with congenital microauricular malformation, the modified Nagata secondary auricle reconstruction method was used, the costal cartilage was removed as the scaffold material for the reconstruction of ear during the operation, and the postoperative costal cartilage and its biological morphology were reconstructed by using three-dimensional CT reconstruction technique. The length, width, radians and inclination of costal cartilage were compared with those before operation to observe the influence on the growth of costal cartilage and the development of thoracic shape in the long term after the removal of costal cartilage and the suture of chondroid membrane in auricle reconstruction. Methods from June 2014 to October 2016, 36 patients with congenital microauricular malformation were treated in plastic and cosmetic surgery of Henan Provincial people's Hospital. All the patients were treated with modified Nagata's second stage method for total ear reconstruction. 26 cases of costal chondrocytes and 10 cases of unclosed costal chondrocytes were treated with "three-dimensional reconstruction of thoracic CT plain scan costal cartilage" in one stage and one week before the second stage of operation respectively. The tissue regeneration between the two groups was compared and analyzed. Results in the closed group, 26 cases (100%) had regenerated tissue, 3 cases (11.5%) had rib cartilage regeneration, and 23 cases (88.5%) had calcification of fibrous tissue. The shape and shape of the fibrous cartilage were basically the same as those before operation. All thorax remained in good shape without obvious depression and angulation deformity. There were 10 cases in unblocked group, 2 cases (20%) were regenerative organizer, all of them were calcification of fibrous tissue. The difference between the two groups was statistically significant (P0.05). Conclusion the preservation of the integrity of costal chondroid membrane in auricular reconstruction is beneficial to the regeneration of cartilage and fibrous tissue and the reduction of the incidence of thoracic deformity after operation. The incidence of thoracic deformities after removal of costal cartilage decreased with age.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R622

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