改进的二期法耳廓再造术

发布时间：2018-05-26 06:30

  本文选题：先天性小耳畸形 + 耳廓再造　； 参考：《山东大学》2011年硕士论文

【摘要】：研究背景： 先天性小耳畸形在我国的发病率约为1.4/万人,由于我国人口众多,所以其患病人数较多。耳廓是构成面部外形的重要器官,其缺失势必会给患者的心理、自信心及日后的社交等方面带来消极影响,因此“还”其形态逼真的耳廓外形可以极大地满足患者的迫切心理需求。先辈们在“还”的道路上为我们打下了坚实的基础,从耳廓再造术到义耳的佩戴无不凝聚了他们的智慧和创造力。Tanzer于1959年最早提出分期行全耳廓再造的手术方法,不仅“还”给患者形态逼真的耳廓外形,更为以后的耳廓再造术的发展打下基础。首先,他提出应用自体肋软骨雕刻成与健侧耳廓基本一致的耳支架,至今自体肋软骨仍被认为是耳再造材料的金标准；其次,他提出分期耳廓再造术,为获得理想的手术效果奠定了基础,因为他不仅使再造耳具备正常耳廓的三维立体结构,还使再造耳能承受一定的生活压力；再次,他开创了耳廓再造术的新纪元,在之后的耳廓再造术基本都足在其基础上发展起来的,如Brent经典四期耳廓再造法、Nagata二期耳廓再造法等。但Tanzer术式需要四期手术,这对患者的经济能力和耐受力是一个极大地考验。正是基于这方面的考虑,之后学者又陆续提出了二期、一期耳廓再造术。具有代表性的是日本学者Nagata报道的二期耳廓再造术。但该方法需要切取4根肋软骨,年龄较小患者胸廓畸形的发生率较高。目前国内学者多采用皮肤软组织扩张法行耳廓再造术。该方法需行三期手术才能完成耳廓再造,而且在皮肤扩张过程中易出现并发症。因此,我们在参考有关文献的基础上对耳廓再造术进行了改进,经过6年的临床应用,获得了较好的手术效果。 目的 探讨一种改进的二期耳廓再造手术方法,总结6年来的临床经验。 材料与方法 在2005-2010年期间共有146例(共155耳)先天性小耳畸形患者接受了改进的二期耳廓再造法进行耳廓再造手术治疗,其中男性109例,女性37例,年龄从5.5-66岁不等,平均年龄为14.8岁,年龄分布：5.5-9岁,29例；10-20岁,98例；21-30岁,17例；30岁以上,2例。在146例中有单侧137例(右侧89例,左侧48例),双侧9例。手术分两期进行：Ⅰ期为耳解剖结构三维轮廓的再造,包括患耳对侧自体第6、7肋软骨的切取、耳支架雕刻成形、残耳的修整、畸形耳软骨切除、将雕刻的耳支架埋置于乳突区皮瓣内、耳垂转位衔接于再造耳的下方。Ⅱ期为耳颅角成形：沿着再造耳的外耳轮外侧5mm切开皮肤,将耳廓掀起,把新月形软骨块置于耳支架下方,分离皮下层次达手术需要后沿筋膜外缘切开,向耳侧翻起剥离筋膜,游离出大小合适的耳后筋膜瓣以包裹耳后支撑支架及Ⅰ期埋植的肋软骨支架,取胸部全厚皮片覆盖创面,打包堆适当加压固定。 结果 经过6个月—2年的随访,148只再造耳获得满意的手术效果,再造耳三维立体轮廓清晰,拥有良好稳定的耳颅角；4例出现皮瓣尖端坏死,经换药后痊愈；1例出现软骨支架外露,通过转移局部皮瓣覆盖后痊愈；2例Ⅱ期术后6个月出现耳颅角回缩；无感染和软骨支架的吸收、变形等并发症。 结论 经过6年的临床应用,该二期耳廓再造法操作相对简单,且并发症较少,获得的手术效果满意,是矫正小耳畸形比较理想的方法。
[Abstract]:Background of Study :

The incidence of congenital microtia in our country is about 140 / million . As a result of the large population of our country , the number of patients is more affected . The auricle is an important organ which forms the shape of the face .
Second , he put forward the stage auricle reconstruction , which laid the foundation for obtaining the ideal operation effect , because he not only has the three - dimensional structure of the normal auricle of the reconstructed ear , but also enables the reconstructed ear to bear a certain living pressure ;
A new era of auricle reconstruction has been developed , which has been developed on the basis of the reconstruction of auricle reconstruction , such as the classic four - stage auricle reconstruction method , Nagata second - phase auricle reconstruction method , etc . However , the method needs to cut 4 costal cartilage , which is a great test for the patient ' s economic ability and tolerance .

Purpose

This paper discusses an improved method for reconstruction of auricle reconstruction in second phase , and summarizes the clinical experience in six years .

Materials and Methods

There were 146 cases ( 155 ears ) of congenital microtia during 2005 - 2010 , including 109 males and 37 females . The age ranged from 5.5 to 66 years , the mean age was 14.8 years , the age distribution was 5.5 to 9 years , 29 cases ;
10 - 20 years , 98 cases ;
21 - 30 years , 17 cases ;
There were 137 cases ( 89 cases on the right side , 48 cases on the left side ) and 9 cases on the bilateral side .

Results

After 6 months - 2 years of follow - up , 148 reconstructed ear had satisfactory operation effect , and the reconstructed ear had a clear three - dimensional contour and had a well - stable auricular angle ;
4 cases had the tip necrosis of the skin flap and recovered after dressing .
In one case , the cartilage stent was exposed and recovered by transfer of partial flap .
After 6 months of phase 鈪，

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