应用低剂量多层螺旋CT评估肋软骨发育指导低龄儿童耳廓再造
发布时间：2018-08-26 10:24
【摘要】：第一部分低剂量多层螺旋CT三维重建技术在肋软骨评估的应用目的：将CT冠状扫描技术与常规轴位扫描技术进行比较,评价冠状扫描技术应用的价值,探索一种肋软骨评估的影像学方法。方法：选择60例于2011年1月到2013年5月行全耳廓再造和听力重建的小耳畸形患儿进行前瞻性对照研究。43例5-7岁患儿行低剂量多层螺旋CT(multi-slice CT, MSCT)冠状扫描,在早期阶段随机选择17例6-8岁患儿行常规轴式扫描。两组间患儿身体质量指数(BMI)无明显差别。术前采用GE Light Speed VCT 64排螺旋CT机(GE公司,美国)扫描患者双侧第1～12肋。低剂量冠状扫描组利用特殊的医用靠背支架扫描,常规轴位扫描组取平卧位常规检查,并应用铅衣保护患儿颈部、下腹部及会阴部,避免不必要的辐射。两组采用如下相同的扫描参数：螺旋模式,管电压100kV,管电流145mA,转速0.4s,层厚5mm,重建层厚0.625mm,螺距1.379。两组有不同的扫描范围：轴位扫描组为250±25.2mmm；冠状扫描组为60±12.2mm。将扫描获得的原始数据输入图像后处理工作站(ADW4.2, GE Medical Systems),应用容积重建(volume rendering technique, VRT)和最大密度投影技术(maximum intensity projection, MIP)三维重建肋软骨和肋骨图像,通过图像观察第5-9肋软骨形态并测量。从CT检查后患者的资料栏中记录CT扫描的容积CT剂量指数(volume CT dose index, CTDIvol),剂量长度乘积(dose-length product, DLP)的数值。CTDIvol显示为2.16HU。由两位经验丰富的副高级以上放射学医师对图像进行双盲法评价,意见不一致时共同协商确定。通过对观察指标包括：图像噪声背景、呼吸伪影干扰程度、肋软骨的完整性、肋软骨三维轮廓及肋软骨弓横断面结构的清晰度及对比度等的评价,将图像分为优、良、差三级。将两组间图像质量、噪声、辐射剂量进行比较。结果：1图像质量图像质量评分中,冠状扫描组优、良、差例数分别为34、8、1,优良以上的比例约为97.67%(42/43)；轴位扫描组优、良、差例数分别为8、7、2,优良以上的比例为88.24%(15/17)；与轴位扫描组相比,冠状扫描组图像质量与之相同(x2=6.33,p0.05)。两组图像噪声分别在T7平面,T11平面,L2平面进行测量；结果显示,各平面噪声相近：两组噪声总体相近,差异无统计学意义(F=1.88,p0.05)。2辐射剂量两组扫描参数相同,CDTIvol值相同。DLP在冠状扫描组和轴位扫描组分别为19.44±3.25HU,68.00±12.36HU。与轴位扫描组相比,冠状扫描组DLP减少约71.41%。冠状扫描组的辐射剂量显著低于轴向扫描组(t=15.98,p0.001)。结论：与常规轴位扫描技术相比,低剂量冠状扫描技术获得的图像质量与之相近,为需耳廓再造的低龄小耳症儿童肋软骨发育的评估提供了一较好的影像学检查方法。第二部分小耳畸形患者肋软骨的发育及对手术时机选择的指导意义目的：应用低剂量螺旋CT三维重建肋软骨形态并测量,探索5-10岁小耳症儿童肋软骨的发育规律；并参照健侧耳廓软骨支架评估肋软骨的发育,寻找一种指导低龄儿童耳廓再造手术时机的方法。方法：对2011年1月至2014年9月期间接受全耳廓再造和听力重建的121例年龄在5-10岁的小耳症患者进行研究。其中右侧小耳畸形78例,左侧43例。耳垂型84例,耳甲腔型33例,不典型4例。每个年龄组中性别分布无明显差异。所有患者均排除了胸壁疾患、胸部创伤史(包括手术、外伤、放疗史等)、胸痛症状、肿瘤史及心肺慢性疾病。患者术前行低剂量颞部及胸部CT扫描。颞部乳突扫描应用低剂量扫描参数设置进行,胸部扫描除在研究早期部分对照组患儿应用常规轴式扫描方式进行外,所有患者均应用低剂量冠状扫描或应用低剂量的自动管电流调制技术进行。将扫描获得的原始数据输入图像后处理工作站(ADW4.2, GE Medical Systems),应用最大密度投影(maximum intensity projection, MIP)及容积重建技术(volume rendering technique, VRT)对肋软骨、肋骨及健侧耳廓软骨支架图像进行三维重建。通过图像观察第5-9肋软骨形态；对双侧第6、7肋软骨联合的宽度和第8肋软骨长度进行测量；其中第8肋软骨的测量从骨软骨交界处至软骨与胸骨连接处或至软骨的游离缘远端。健侧耳廓软骨支架的有效耳轮长度的测量从耳轮脚始至耳轮融入耳垂交界处,约在与耳屏间切迹平齐水平。术中切取患耳对侧第6、7、8肋软骨。术中肋软骨采集后即刻应用显微外科游标卡尺对切取的第6、7肋软骨联合的宽度进行测量,应用外科直尺对第8肋软骨全长进行测量。所有测量重复3次,取均值作为最终测量结果。将术前测定的患耳对侧的第8肋软骨长度与健侧耳廓软骨支架耳轮的长度相配比,并同时参考患儿父母耳廓的大小,决定手术时机。若二者接近,同时患儿耳廓大小尺寸与其父母耳廓大小尺寸无较大差别,手术医生决定开始一期手术；若术前测定的拟切取的患耳对侧的第8肋软骨的长度明显短于健侧耳廓软骨支架耳轮的长度,超过2.5cm,手术医生通过告知、劝说患者及父母后推迟手术。一期手术的结果由手术医生和患者父母共同评价。两方对结果均满意为结果满意,患者一方满意为结果可接受,患者不满意或二者均不满意为结果不良。评价标准从再造耳廓的外形、大小尺寸、耳廓的位置、和再造耳廓结构的细节显示等方面进行,其中对耳轮脚的形态和耳轮耳垂融合处形态是否流畅、有无凹陷切迹重点评估。其中,满意结果标准为：外形良好、大小尺寸精准,耳廓位置与对侧对称,再造耳廓形态逼真,耳轮脚形态显示良好,耳轮与耳垂融合处形态流畅；可接受结果为：外形良好、大小尺寸精准,耳廓位置与对侧对称,再造耳廓形态逼真,耳轮脚长度稍短,耳轮与耳垂融合处形态基本流畅；不良结果为：外形差,耳轮脚形态显示不佳,耳轮与耳垂融合处形态不流畅,存在切迹。对拟切取的患耳对侧的肋软骨术前测量与术后测量数据的一致性进行了线性回归与相关分析,对第6、7肋软骨联合和第8肋软骨发育的趋势进行了描述和比较。对手术结果进行了分析。结果：1术前测量与术后测量结果的一致性术前测定的拟切取的第6,7肋软骨联合的宽度、第8肋软骨的长度分别与术中测定的真实结果接近。第6、7肋软骨联合宽度的术前图像测量与术中测量的真实宽度满足线性回归关系(r=0.60,P0.05)。第8肋软骨长度的术前图像测量与术中测量真实长度满足线性回归关系(r=0.58,P0.05)。2肋软骨和健侧耳廓软骨支架耳轮的发育5～10岁,第6、7肋软骨联合宽度的生长发育较缓慢,呈非线性状态。第8肋软骨的发育呈非线性状态,变化较大。可能由于第8肋软骨从与胸骨相连状态到变成浮肋状态的年龄不确定性比较大有关。总体上,第6、7肋软骨联合宽度男女相近,在女性稍大；第8肋软骨的发育没有明显性别差异。总体上第6、7肋软骨联合宽度左右相近,左侧稍宽；第8肋软骨的发育无侧别的差异。5-10岁,健侧耳廓软骨支架耳轮的生长发育较缓慢,呈非线性状态。总体上,健耳软骨支架耳轮的发育无性别差异。3临床手术结果根据术前测定的患耳对侧第8肋软骨长度与健侧耳廓支架耳轮长度的相近程度,对121例患者进行了手术治疗或推迟手术治疗。76(62.8%)例患者第8肋软骨长度与健侧耳廓软骨支架耳轮长度接近,应用完整的第8肋软骨雕刻形成再造耳支架耳轮和耳轮脚,取得满意手术结果；18(14.9%)例患者第8肋软骨长度较健侧耳廓软骨支架耳轮长度略短,相差1.0cm,通过调整再造耳廓支架耳轮脚长度,缩短耳轮脚从而达到外耳轮向耳垂部延长,亦取得满意结果。17(14.0%)例患者第8肋软骨长度较健侧耳廓软骨支架耳轮长度短,相差1.5cm,应用第8肋软骨与零碎软骨条雕刻拼接形成再造耳廓支架耳轮,使耳轮长度达到与耳垂衔接处,取得可接受结果。9(7.4%)例患者由于第8肋软骨长度较短,与健侧耳廓软骨支架耳轮长度相差较大,超过2.5cm,推迟了手术。1(0.8%)例早期的患者长度不足,第8肋软骨长度较健侧耳廓软骨支架耳轮长度短约2.3cm,在患者父母的强烈要求下手术,由于我们早期经验不足,未取得良好结果。手术结果在不同年龄组间的分布显示：各组间手术结果满意率相近(p0.05),但随年龄增大手术结果的满意率有增加的趋势。结论：5～10岁小耳畸形儿童第6、7肋软骨联合的生长比较迟缓；第8肋软骨的发育变化较大,无规律可循。将第8肋软骨的长度参照健侧耳廓软骨支架耳轮的长度可指导耳廓再造的手术时机,并开启低龄儿童耳廓再造的个体化治疗。肋软骨CT三维重建评估并指导低龄小耳患者耳廓再造提供了一可预测手术结果的方法,既保证了再造耳廓的形态,又可尽早解决患儿的心理发育问题。
[Abstract]:Part I Application of low-dose multi-slice spiral CT three-dimensional reconstruction technique in costal cartilage evaluation Objective: To compare CT coronal scanning technique with conventional axial scanning technique, evaluate the application value of coronal scanning technique, and explore an imaging method for costal cartilage evaluation. A prospective controlled study was conducted in 43 children aged 5-7 years with microtia who underwent low-dose multi-slice spiral CT (MSCT) coronal scan. 17 children aged 6-8 years were randomly selected for routine axial scan at the early stage. There was no significant difference in body mass index (BMI) between the two groups. 64-slice spiral CT (GE, USA) scans bilateral ribs 1-12. Low-dose coronal scans were performed with special medical backrest scaffolds. Routine axial scans were performed in the supine position. Lead coats were used to protect the neck, lower abdomen and perineum from unnecessary radiation. In spiral mode, the tube voltage is 100kV, the tube current is 145mA, the rotational speed is 0.4s, the layer thickness is 5mm, the reconstructed layer thickness is 0.625mm, the pitch is 1.379. The two groups have different scanning ranges: the axial scanning group is 250 + 25.2mmm, the coronal scanning group is 60 + 12.2mm. The volume rendering technique (VRT) and the maximum intensity projection (MIP) were used to reconstruct the costal cartilage and rib images. The shape of costal cartilage was observed and measured by the images. The volume CT dose index (CTDIvol) and the dose-length multiplication were recorded from the data bar of the patients after CT examination. CTDIvol was displayed at 2.16HU. Two experienced radiologists at or above the deputy senior level evaluated the images by double-blind method and agreed to determine if they disagreed. The image quality, noise and radiation dose were compared between the two groups. Results: 1 In the image quality score, the coronal scan group was excellent, good, and the difference cases were 34, 8, 1, respectively. The ratio of excellent and above was 97.67% (42/43). Compared with the axial scan group, the image quality of the coronal scan group was the same (x2 = 6.33, p0.05). The image noise of the two groups were measured in T7 plane, T11 plane and L2 plane respectively. The results showed that the noise of each plane was similar: the noise of the two groups was similar in general, and the difference was similar. There was no significant difference between the two groups (F = 1.88, p0.05). 2 Radiation dosage of the two groups was the same, the CDTIvol value was the same. DLP in the coronal scan group and the axial scan group was 19.44 (+ 3.25) HU, 68.00 (+ 12.36) HU, respectively. Compared with the axial scan group, the DLP in the coronal scan group decreased about 71.41%. The radiation dosage in the coronal scan group was significantly lower than that in the axial scan group (t = 15.98, p0.001). CONCLUSION: Compared with conventional axial scanning, low dose coronal scanning provides a better imaging method for the evaluation of costal cartilage development in children with microtia requiring auricle reconstruction. Part II The development of costal cartilage in patients with microtia and its guiding significance for the timing of surgery. Objective: To explore the development of costal cartilage in children with microtia aged 5-10 years by using low-dose spiral CT three-dimensional reconstruction and measurement of costal cartilage morphology, and to evaluate the development of costal cartilage with reference to healthy lateral auricular cartilage scaffold, so as to find a method to guide the timing of auricular reconstruction in young children. Total auricle reconstruction and auditory reconstruction were performed in 121 patients aged 5-10 years with microtia, including 78 cases of right microtia, 43 cases of left microtia, 84 cases of lobe type, 33 cases of concha cavity type, and 4 cases of atypia. Preoperative low-dose temporal and thoracic CT scans were performed. Temporal mastoid scans were performed with low-dose scanning parameters. Thoracic scans were performed with low-dose coronal or low-dose coronal scans, except for routine axial scans in some of the early control groups. Low-dose automatic tube current modulation technique was used to input the original data obtained from the scanning into the image post-processing workstation (ADW4.2, GE Medical Systems) and to apply maximum intensity projection (MIP) and volume rendering technique (VRT) to the cartilage branches of costal cartilage, rib and contralateral auricle. 3-D reconstruction of the scaffolds was performed. The shape of the 5-9 costal cartilage was observed. The width of the 6,7 costal cartilage Union and the length of the 8 costal cartilage were measured. The 8 costal cartilage was measured from the junction of the cartilage and the sternum to the distal end of the free edge of the cartilage. The 6,7,8 costal cartilage of the contralateral side of the affected ear was harvested during the operation. The width of the 6,7 costal cartilage syndesmosis was measured immediately after harvesting the costal cartilage. The 8 costal cartilage was measured with a surgical ruler. Quantity. All measurements were repeated three times and the mean was taken as the final measurement. The eighth costal cartilage length of the contralateral side of the affected ear was matched with the length of the contralateral auricular cartilage bracket ear wheel, and the timing of the operation was determined by referring to the size of the parents'auricles. If the two were close, the size of the affected ear and the size of the parents' auricles would be the same. If the length of the contralateral costal cartilage measured before surgery is significantly shorter than that of the contralateral ear cartilage bracket ear wheel, exceeding 2.5 cm, the surgeon advises the patient and his parents to postpone the operation. Parents shared the evaluation. Both sides were satisfied with the results, one side was satisfied with the results, the other was acceptable, the other was unsatisfied or both were unsatisfactory. The evaluation criteria included the shape, size, location of the reconstructed auricle, and the detail display of the reconstructed auricle structure, including the shape of the auricle wheel foot and the ear. Whether the fusion of the earlobes is smooth or not, and whether there is concave notch, the criteria of satisfactory results are: good shape, accurate size, symmetrical location of the auricle and the opposite side, realistic shape of the reconstructed auricle, good appearance of the foot of the auricle, smooth shape of the fusion of the earlobes and the earlobes; acceptable results are: good shape, size and size. Accurate, symmetrical and contralateral auricle position, realistic reconstructed auricle shape, slightly shorter auricular wheel foot length, ear wheel and earlobe fusion of the basic smooth shape; the bad results are: poor shape, ear wheel foot shape display is not good, ear wheel and earlobe fusion of the shape is not smooth, there is a notch. The consistency of the measurement data was analyzed by linear regression and correlation analysis, and the development trend of the 6th and 7th costal cartilage Union and the 8th costal cartilage were described and compared. The preoperative image measurement of the joint width of costal cartilage and the real width measured during the operation were linear regression (r = 0.60, P 0.05). The preoperative image measurement of the eighth costal cartilage and the real length measured during the operation were linear regression (r = 0.58, P 0.05). 2 costal cartilage and contralateral auricle. The development of cartilage scaffold Earrings ranged from 5 to 10 years old, and the width of costal cartilage union at 6 and 7 years old was slow and nonlinear. The development of costal cartilage at 8 was nonlinear and varied greatly. This may be due to the age uncertainty of the 8th costal cartilage from sternal to floating costal. In general, the width of costal cartilage Union in the 6th and 7th costal cartilage union is similar to that in the left side, and the development of the 8th costal cartilage has no lateral difference. There was no gender difference in the development of the ear ring. 3 According to the length of the contralateral eighth costal cartilage measured before operation, 121 patients were treated with surgery or postponed surgery. 76 (62.8%) patients had the same length of the eighth costal cartilage as the contralateral ear cartilage. 18 (14.9%) of the patients had a slightly shorter and 1.0 cm difference in the length of the ear ring of the cartilage scaffold on the eighth costal cartilage than that on the healthy side. 17 (14.0%) of the patients had shorter ear ring length of the 8th costal cartilage than that of the healthy ear cartilage stent, the difference was 1.5 cm. The 8th costal cartilage was carved and spliced with fragmentary cartilage strips to form a reconstructed ear ring. The length of the ear ring reached the junction of the earlobe. The acceptable result was obtained in 9 (7.4%) of the patients because the 8th costal cartilage was longer. Short, and the contralateral auricular cartilage stent ear wheel length difference is large, more than 2.5 cm, delayed the operation. 1 (0.8%) cases of early insufficient length, the eighth costal cartilage length is shorter than contralateral auricular cartilage stent ear wheel length about 2.3 cm, in the patient's parents under the strong request of surgery, due to our lack of early experience, did not achieve good results. Distribution among different age groups showed that the satisfactory rate of surgical results was similar among all groups (p0.05), but the satisfactory rate of surgical results increased with age. Conclusion: The growth of costal cartilage Union in children with microtia aged from 5 to 10 years old was relatively slow; the development of costal cartilage in the eighth costal cartilage changed greatly and could not be followed regularly. According to the length of the ear wheel of the healthy side of the auricle cartilage scaffold, the timing of auricle reconstruction can be guided and individual treatment of auricle reconstruction can be opened in young children. Determine the psychological development of children.
【学位授予单位】：山东大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R764.9
本文编号：2204569
[Abstract]:Part I Application of low-dose multi-slice spiral CT three-dimensional reconstruction technique in costal cartilage evaluation Objective: To compare CT coronal scanning technique with conventional axial scanning technique, evaluate the application value of coronal scanning technique, and explore an imaging method for costal cartilage evaluation. A prospective controlled study was conducted in 43 children aged 5-7 years with microtia who underwent low-dose multi-slice spiral CT (MSCT) coronal scan. 17 children aged 6-8 years were randomly selected for routine axial scan at the early stage. There was no significant difference in body mass index (BMI) between the two groups. 64-slice spiral CT (GE, USA) scans bilateral ribs 1-12. Low-dose coronal scans were performed with special medical backrest scaffolds. Routine axial scans were performed in the supine position. Lead coats were used to protect the neck, lower abdomen and perineum from unnecessary radiation. In spiral mode, the tube voltage is 100kV, the tube current is 145mA, the rotational speed is 0.4s, the layer thickness is 5mm, the reconstructed layer thickness is 0.625mm, the pitch is 1.379. The two groups have different scanning ranges: the axial scanning group is 250 + 25.2mmm, the coronal scanning group is 60 + 12.2mm. The volume rendering technique (VRT) and the maximum intensity projection (MIP) were used to reconstruct the costal cartilage and rib images. The shape of costal cartilage was observed and measured by the images. The volume CT dose index (CTDIvol) and the dose-length multiplication were recorded from the data bar of the patients after CT examination. CTDIvol was displayed at 2.16HU. Two experienced radiologists at or above the deputy senior level evaluated the images by double-blind method and agreed to determine if they disagreed. The image quality, noise and radiation dose were compared between the two groups. Results: 1 In the image quality score, the coronal scan group was excellent, good, and the difference cases were 34, 8, 1, respectively. The ratio of excellent and above was 97.67% (42/43). Compared with the axial scan group, the image quality of the coronal scan group was the same (x2 = 6.33, p0.05). The image noise of the two groups were measured in T7 plane, T11 plane and L2 plane respectively. The results showed that the noise of each plane was similar: the noise of the two groups was similar in general, and the difference was similar. There was no significant difference between the two groups (F = 1.88, p0.05). 2 Radiation dosage of the two groups was the same, the CDTIvol value was the same. DLP in the coronal scan group and the axial scan group was 19.44 (+ 3.25) HU, 68.00 (+ 12.36) HU, respectively. Compared with the axial scan group, the DLP in the coronal scan group decreased about 71.41%. The radiation dosage in the coronal scan group was significantly lower than that in the axial scan group (t = 15.98, p0.001). CONCLUSION: Compared with conventional axial scanning, low dose coronal scanning provides a better imaging method for the evaluation of costal cartilage development in children with microtia requiring auricle reconstruction. Part II The development of costal cartilage in patients with microtia and its guiding significance for the timing of surgery. Objective: To explore the development of costal cartilage in children with microtia aged 5-10 years by using low-dose spiral CT three-dimensional reconstruction and measurement of costal cartilage morphology, and to evaluate the development of costal cartilage with reference to healthy lateral auricular cartilage scaffold, so as to find a method to guide the timing of auricular reconstruction in young children. Total auricle reconstruction and auditory reconstruction were performed in 121 patients aged 5-10 years with microtia, including 78 cases of right microtia, 43 cases of left microtia, 84 cases of lobe type, 33 cases of concha cavity type, and 4 cases of atypia. Preoperative low-dose temporal and thoracic CT scans were performed. Temporal mastoid scans were performed with low-dose scanning parameters. Thoracic scans were performed with low-dose coronal or low-dose coronal scans, except for routine axial scans in some of the early control groups. Low-dose automatic tube current modulation technique was used to input the original data obtained from the scanning into the image post-processing workstation (ADW4.2, GE Medical Systems) and to apply maximum intensity projection (MIP) and volume rendering technique (VRT) to the cartilage branches of costal cartilage, rib and contralateral auricle. 3-D reconstruction of the scaffolds was performed. The shape of the 5-9 costal cartilage was observed. The width of the 6,7 costal cartilage Union and the length of the 8 costal cartilage were measured. The 8 costal cartilage was measured from the junction of the cartilage and the sternum to the distal end of the free edge of the cartilage. The 6,7,8 costal cartilage of the contralateral side of the affected ear was harvested during the operation. The width of the 6,7 costal cartilage syndesmosis was measured immediately after harvesting the costal cartilage. The 8 costal cartilage was measured with a surgical ruler. Quantity. All measurements were repeated three times and the mean was taken as the final measurement. The eighth costal cartilage length of the contralateral side of the affected ear was matched with the length of the contralateral auricular cartilage bracket ear wheel, and the timing of the operation was determined by referring to the size of the parents'auricles. If the two were close, the size of the affected ear and the size of the parents' auricles would be the same. If the length of the contralateral costal cartilage measured before surgery is significantly shorter than that of the contralateral ear cartilage bracket ear wheel, exceeding 2.5 cm, the surgeon advises the patient and his parents to postpone the operation. Parents shared the evaluation. Both sides were satisfied with the results, one side was satisfied with the results, the other was acceptable, the other was unsatisfied or both were unsatisfactory. The evaluation criteria included the shape, size, location of the reconstructed auricle, and the detail display of the reconstructed auricle structure, including the shape of the auricle wheel foot and the ear. Whether the fusion of the earlobes is smooth or not, and whether there is concave notch, the criteria of satisfactory results are: good shape, accurate size, symmetrical location of the auricle and the opposite side, realistic shape of the reconstructed auricle, good appearance of the foot of the auricle, smooth shape of the fusion of the earlobes and the earlobes; acceptable results are: good shape, size and size. Accurate, symmetrical and contralateral auricle position, realistic reconstructed auricle shape, slightly shorter auricular wheel foot length, ear wheel and earlobe fusion of the basic smooth shape; the bad results are: poor shape, ear wheel foot shape display is not good, ear wheel and earlobe fusion of the shape is not smooth, there is a notch. The consistency of the measurement data was analyzed by linear regression and correlation analysis, and the development trend of the 6th and 7th costal cartilage Union and the 8th costal cartilage were described and compared. The preoperative image measurement of the joint width of costal cartilage and the real width measured during the operation were linear regression (r = 0.60, P 0.05). The preoperative image measurement of the eighth costal cartilage and the real length measured during the operation were linear regression (r = 0.58, P 0.05). 2 costal cartilage and contralateral auricle. The development of cartilage scaffold Earrings ranged from 5 to 10 years old, and the width of costal cartilage union at 6 and 7 years old was slow and nonlinear. The development of costal cartilage at 8 was nonlinear and varied greatly. This may be due to the age uncertainty of the 8th costal cartilage from sternal to floating costal. In general, the width of costal cartilage Union in the 6th and 7th costal cartilage union is similar to that in the left side, and the development of the 8th costal cartilage has no lateral difference. There was no gender difference in the development of the ear ring. 3 According to the length of the contralateral eighth costal cartilage measured before operation, 121 patients were treated with surgery or postponed surgery. 76 (62.8%) patients had the same length of the eighth costal cartilage as the contralateral ear cartilage. 18 (14.9%) of the patients had a slightly shorter and 1.0 cm difference in the length of the ear ring of the cartilage scaffold on the eighth costal cartilage than that on the healthy side. 17 (14.0%) of the patients had shorter ear ring length of the 8th costal cartilage than that of the healthy ear cartilage stent, the difference was 1.5 cm. The 8th costal cartilage was carved and spliced with fragmentary cartilage strips to form a reconstructed ear ring. The length of the ear ring reached the junction of the earlobe. The acceptable result was obtained in 9 (7.4%) of the patients because the 8th costal cartilage was longer. Short, and the contralateral auricular cartilage stent ear wheel length difference is large, more than 2.5 cm, delayed the operation. 1 (0.8%) cases of early insufficient length, the eighth costal cartilage length is shorter than contralateral auricular cartilage stent ear wheel length about 2.3 cm, in the patient's parents under the strong request of surgery, due to our lack of early experience, did not achieve good results. Distribution among different age groups showed that the satisfactory rate of surgical results was similar among all groups (p0.05), but the satisfactory rate of surgical results increased with age. Conclusion: The growth of costal cartilage Union in children with microtia aged from 5 to 10 years old was relatively slow; the development of costal cartilage in the eighth costal cartilage changed greatly and could not be followed regularly. According to the length of the ear wheel of the healthy side of the auricle cartilage scaffold, the timing of auricle reconstruction can be guided and individual treatment of auricle reconstruction can be opened in young children. Determine the psychological development of children.
【学位授予单位】：山东大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R764.9
【参考文献】
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1 林子豪;先天性小耳畸形的MEDPOR支架耳再造术[J];第二军医大学学报;2005年01期
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