封閉肋軟骨膜對軟骨修復再生影響的研究
發(fā)布時間：2018-12-12 18:43
【摘要】：背景小耳畸形是較常見的耳廓先天性發(fā)育不良,常伴有外耳道閉鎖、中耳畸形、頜面部畸形以及其他系統(tǒng)器官畸形,在頜面部先天畸形中僅次于唇腭裂的發(fā)病率。耳廓再造手術仍是目前最有效的治療方法。自體肋軟骨由于其良好的組織相容性、無排異反應、易于獲取、較好的抗壓能力等優(yōu)點已成為公認的最佳的再造支架來源。但是由于軟骨的再生能力較差,切取大量肋軟骨會破壞胸廓結構的完整性,降低胸廓的穩(wěn)定性,耳再造術又多在青少年時期進行,隨生長發(fā)育,可能會導致胸廓畸形和反常呼吸。目前已經(jīng)有越來越多的學者關注到了此問題,并對其做了大量研究以期減少術后胸廓畸形的發(fā)生。部分學者提出了術中切取肋軟骨同時保留軟骨膜和骨-軟骨連接處(CCJ)等,這些方法都已經(jīng)被證實是可以有效促進纖維組織生長的。也有學者提出切取肋軟骨進行雕刻后將剩余的軟骨碎屑再次回植于軟骨膜內(nèi),并進行了實驗研究,然而其具體機制及效果目前尚未明確,亦缺乏臨床研究數(shù)據(jù)。另有醫(yī)生提出將肋軟骨碎屑中加入生物材料一并回植于切取軟骨后的供區(qū)軟骨膜內(nèi),此種方法僅為動物實驗,尚未能應用于臨床工作之中。本實驗擬運用三維CT重建技術收集影像學資料,分析耳廓再造術中切取肋軟骨后封閉軟骨膜對肋軟骨、纖維組織修復再生及胸廓發(fā)育的影響。目的以先天小耳畸形患者為研究對象,采用改良的Nagata二期耳廓再造法行手術治療,術中切取肋軟骨作為再造耳支架材料,運用三維CT重建技術,重建術后肋軟骨及再生物形態(tài),分別在長度、寬度、弧度、傾斜度等方面與術前進行對比,觀察耳廓再造術中切取肋軟骨后縫合軟骨膜與否對肋軟骨的生長及遠期胸廓形態(tài)發(fā)育的影響。方法收集2014年6月~2016年10月于河南省人民醫(yī)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二期法行全耳再造術。術中封閉肋軟骨膜26例,未封閉肋軟骨膜10例,每例患者分別于一期術前、二期術前一周內(nèi)行“胸廓CT平掃+肋軟骨三維重建”,對比分析兩組患者間組織再生的情況。結果封閉組共26例,均可見再生組織(100%),肋軟骨再生者3例(11.5%),纖維組織鈣化者23例(88.5%),形態(tài)、走形與術前肋軟骨基本一致,胸廓均保持良好形態(tài),未見明顯凹陷和成角畸形。未封閉組共10例,見再生組織者2例(20%),均為纖維組織鈣化。兩組相比較差異具有統(tǒng)計學意義(P0.05)。結論耳廓再造術中盡可能的保留肋軟骨膜的完整性,并將其封閉為管套狀結構有利于軟骨及纖維組織的再生,降低術后胸廓畸形的發(fā)生率;切取肋軟骨后胸廓畸形的發(fā)生率隨年齡增長逐漸下降。
[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.
【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R622
本文編號：2375108
[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.
【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R622
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