自体肋软骨复合体移植矫治医源性鼻中隔塌陷

罗德丰+鲍义华+曾庆

[摘要]目的：探讨肋软骨支架矫治鼻整形术后继发鼻中隔塌陷畸形的方法。方法：对鼻整形术后继发鼻中隔塌陷的15例女性患者，取其第6或第7肋软骨3cm长和2cm×1cm软骨膜，制备厚度1.5mm软骨片，制作成倒“T”形支架，螺钉固定于上颌骨鼻脊，重建鼻中隔；调整鼻中隔、鼻尖高度，软骨膜覆盖；柳叶形鼻假体改善鼻背外形。结果：15例患者鼻部外观均见明显改善，鼻尖高度恢复正常。术后2年对患者进行随访，其中2例鼻小柱轻度偏曲，无需处理。结论：肋软骨制作的复合体支架能有效重建鼻中隔生理结构。

[关键词]隆鼻术；鼻中隔塌陷；肋软骨；鼻脊；肋软骨复合体；修复重建

[中图分类号]R622 [文献标志码]A [文章编号]1008-6455（2017）10-0018-02

Abstract： Objective To investigate the method of the nasal septal collapse secondary to rhinoplasty. Methods 15 cases with nasal septal collapse secondary after being had rhinoplasty， were cut 3cm length of the sixth and seventh costal cartilage， and perichondrium about 2cm length and 1cm width， then to slice the costal cartilage into 1.5mm thin slices， made the slices into inverted “T” brackets， and used screws to fix the brackets to the maxillary nasospinale，in order to reconstruct the nasal septum，coverd the brackets with the perichondrium after adjusting the height of the nasal septum and apex nasi. In the end，used the willow leaf shape of the nasal prosthesis to improve the appearance of the nasal dorsum. Results Nasal appearance of all the 15 women was improved a lot，with the height of their nose tip getting normal level. All the patients were followed up，and two of them had nasal small column slightly eccentric，however， without the necessity to adjust. Conclusion The complex brackets of costal cartilage can effectively reconstruct the physiological structure of nasal septal.

Key words： rhinoplasty； nasal septal collapse； costal cartilage； nose ridge； costal cartilage complex； repair and reconstruction

近年来各类隆鼻手术大量开展，由于各种原因导致的鼻中隔塌陷时有发生，严重影响患者外貌及鼻腔通气功能。笔者以2014年10月-2016年4月自体鼻中隔软骨移植鼻整形术后继发鼻中隔塌陷患者为研究对象，采用肋软骨复合体重建鼻中隔方案，取得了良好的临床效果[1]。

1 临床资料

本组患者15例，均为女性，年龄22～34岁，全部为鼻整形术后鼻中隔塌陷。完善术前检查，排除手术治疗禁忌证，均行肋软骨重建鼻中隔鼻整形术。术后随访调查，随访时间最长2年，最短8个月，所有随访患者随访期内鼻部均未行其他治疗。

2 手术方法

2.1 鼻中隔塑形材料准备：取第6或者第7肋软骨，长度约3cm（图1），顺带取出长约2cm、宽度1cm的软骨膜备用[2]。软骨取出后生理盐水浸泡30min，让软骨完全回弹，避免软骨切片和雕刻后变形。……