發(fā)布時間：2018-05-26 06:30

  本文選題：先天性小耳畸形 + 耳廓再造��； 參考：《山東大學(xué)》2011年碩士論文

【摘要】：研究背景： 先天性小耳畸形在我國的發(fā)病率約為1.4/萬人,由于我國人口眾多,所以其患病人數(shù)較多。耳廓是構(gòu)成面部外形的重要器官,其缺失勢必會給患者的心理、自信心及日后的社交等方面帶來消極影響,因此“還”其形態(tài)逼真的耳廓外形可以極大地滿足患者的迫切心理需求。先輩們在“還”的道路上為我們打下了堅實的基礎(chǔ),從耳廓再造術(shù)到義耳的佩戴無不凝聚了他們的智慧和創(chuàng)造力。Tanzer于1959年最早提出分期行全耳廓再造的手術(shù)方法,不僅“還”給患者形態(tài)逼真的耳廓外形,更為以后的耳廓再造術(shù)的發(fā)展打下基礎(chǔ)。首先,他提出應(yīng)用自體肋軟骨雕刻成與健側(cè)耳廓基本一致的耳支架,至今自體肋軟骨仍被認(rèn)為是耳再造材料的金標(biāo)準(zhǔn)；其次,他提出分期耳廓再造術(shù),為獲得理想的手術(shù)效果奠定了基礎(chǔ),因為他不僅使再造耳具備正常耳廓的三維立體結(jié)構(gòu),還使再造耳能承受一定的生活壓力；再次,他開創(chuàng)了耳廓再造術(shù)的新紀(jì)元,在之后的耳廓再造術(shù)基本都足在其基礎(chǔ)上發(fā)展起來的,如Brent經(jīng)典四期耳廓再造法、Nagata二期耳廓再造法等。但Tanzer術(shù)式需要四期手術(shù),這對患者的經(jīng)濟(jì)能力和耐受力是一個極大地考驗。正是基于這方面的考慮,之后學(xué)者又陸續(xù)提出了二期、一期耳廓再造術(shù)。具有代表性的是日本學(xué)者Nagata報道的二期耳廓再造術(shù)。但該方法需要切取4根肋軟骨,年齡較小患者胸廓畸形的發(fā)生率較高。目前國內(nèi)學(xué)者多采用皮膚軟組織擴(kuò)張法行耳廓再造術(shù)。該方法需行三期手術(shù)才能完成耳廓再造,而且在皮膚擴(kuò)張過程中易出現(xiàn)并發(fā)癥。因此,我們在參考有關(guān)文獻(xiàn)的基礎(chǔ)上對耳廓再造術(shù)進(jìn)行了改進(jìn),經(jīng)過6年的臨床應(yīng)用,獲得了較好的手術(shù)效果。 目的 探討一種改進(jìn)的二期耳廓再造手術(shù)方法,總結(jié)6年來的臨床經(jīng)驗。 材料與方法 在2005-2010年期間共有146例(共155耳)先天性小耳畸形患者接受了改進(jìn)的二期耳廓再造法進(jìn)行耳廓再造手術(shù)治療,其中男性109例,女性37例,年齡從5.5-66歲不等,平均年齡為14.8歲,年齡分布：5.5-9歲,29例；10-20歲,98例；21-30歲,17例；30歲以上,2例。在146例中有單側(cè)137例(右側(cè)89例,左側(cè)48例),雙側(cè)9例。手術(shù)分兩期進(jìn)行：Ⅰ期為耳解剖結(jié)構(gòu)三維輪廓的再造,包括患耳對側(cè)自體第6、7肋軟骨的切取、耳支架雕刻成形、殘耳的修整、畸形耳軟骨切除、將雕刻的耳支架埋置于乳突區(qū)皮瓣內(nèi)、耳垂轉(zhuǎn)位銜接于再造耳的下方。Ⅱ期為耳顱角成形：沿著再造耳的外耳輪外側(cè)5mm切開皮膚,將耳廓掀起,把新月形軟骨塊置于耳支架下方,分離皮下層次達(dá)手術(shù)需要后沿筋膜外緣切開,向耳側(cè)翻起剝離筋膜,游離出大小合適的耳后筋膜瓣以包裹耳后支撐支架及Ⅰ期埋植的肋軟骨支架,取胸部全厚皮片覆蓋創(chuàng)面,打包堆適當(dāng)加壓固定。 結(jié)果 經(jīng)過6個月—2年的隨訪,148只再造耳獲得滿意的手術(shù)效果,再造耳三維立體輪廓清晰,擁有良好穩(wěn)定的耳顱角；4例出現(xiàn)皮瓣尖端壞死,經(jīng)換藥后痊愈；1例出現(xiàn)軟骨支架外露,通過轉(zhuǎn)移局部皮瓣覆蓋后痊愈；2例Ⅱ期術(shù)后6個月出現(xiàn)耳顱角回縮；無感染和軟骨支架的吸收、變形等并發(fā)癥。 結(jié)論 經(jīng)過6年的臨床應(yīng)用,該二期耳廓再造法操作相對簡單,且并發(fā)癥較少,獲得的手術(shù)效果滿意,是矯正小耳畸形比較理想的方法。
[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，

本文編號：1936287