混合耳软骨-ePTFE技术在特定初次鼻整形汉族患者中用于有限鼻延长与增高的应用

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中文摘要

背景： 增高鼻整形术在汉族患者中较为常见。尽管肋软骨可提供充足的移植材料，但其取材增加了手术复杂性及供区并发症。本研究评估了一种选择性混合技术，将自体耳软骨与膨体聚四氟乙烯（ePTFE）植入物相结合，用于经过严格筛选的初次手术患者的鼻背增高、有限鼻延长及鼻尖精雕。
目的： 评估采用ePTFE植入物进行鼻背增高和有限鼻延长、并结合耳软骨移植用于鼻尖支撑、轮廓精雕及远端植入物保护的混合技术相关的术后人体测量学结果及植入物相关并发症。
方法： 本回顾性病例系列纳入137例于2016年12月至2022年7月期间接受初次鼻整形术的轻度短鼻或接近正常鼻的汉族女性患者。仅随访时间至少24个月的患者被纳入临床分析。所有患者均接受定制雕刻的I形ePTFE植入物以进行鼻背增高和有限鼻延长支撑，并联合单侧耳软骨移植进行鼻尖修整。采用配对t检验比较标准化的术前和术后人体测量学指标。
结果： 随访时间为24至60个月，平均36.2个月。并发症包括：3例（2.2%）植入物偏斜需修整，2例（1.5%）术后早期感染，1例（0.7%）迟发感染，6例（4.3%）鼻背高度或鼻尖突度不足。平均鼻长度由术前的43.0 ± 1.9 mm增加至术后的45.0 ± 1.8 mm，P < 0.05。平均鼻尖突度由19.0 ± 1.6 mm增加至23.0 ± 1.7 mm，P < 0.001。平均鼻唇角由100.7 ± 5.33°变为98.2 ± 3.43°，P < 0.05。在可获得的随访期内未观察到植入物外露。
结论： 在经筛选的初次鼻整形汉族患者中，这种ePTFE-耳软骨混合技术可能是鼻背增高、有限鼻延长及鼻尖精雕的一种有用选择。该方法可能有助于在轻度病例中实现美学目标，而无需常规切取肋软骨。然而，这些发现应在回顾性病例系列且随访至少24个月的背景下进行解读，仍需更长时间的随访以进一步评估迟发性植入物相关并发症及美学效果的持久性。
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英文摘要

BACKGROUND: Augmentation rhinoplasty is commonly performed in Han Chinese patients. Although costal cartilage provides abundant graft material, its harvest increases operative complexity and donor-site morbidity. This study evaluated a selective hybrid technique combining autologous auricular cartilage with an expanded polytetrafluoroethylene (ePTFE) implant for dorsal augmentation, limited nasal lengthening, and tip refinement in carefully selected primary patients.
OBJECTIVES: To evaluate postoperative anthropometric outcomes and implant-related complications associated with a hybrid technique using an ePTFE implant for dorsal augmentation and limited nasal lengthening, combined with auricular cartilage grafting for tip support, contour refinement, and distal implant shielding.
METHODS: This retrospective case series included 137 female Han Chinese patients with mildly short or near-normal noses who underwent primary rhinoplasty between December 2016 and July 2022. Only patients with a minimum follow-up of 24 months were included in the clinical analysis. All patients received a custom-carved I-shaped ePTFE implant for dorsal augmentation and limited nasal lengthening support, together with unilateral auricular cartilage grafting for tip modification. Standardized preoperative and postoperative anthropometric measurements were compared using paired t tests.
RESULTS: Follow-up ranged from 24 to 60 months, with a mean duration of 36.2 months. Complications included implant deviation requiring revision in 3 patients, 2.2%, early postoperative infection in 2, 1.5%, late infection in 1, 0.7%, and inadequate dorsal height or tip projection in 6, 4.3%. Mean nasal length increased from 43.0 ± 1.9 mm preoperatively to 45.0 ± 1.8 mm postoperatively, P < 0.05. Mean nasal tip projection increased from 19.0 ± 1.6 mm to 23.0 ± 1.7 mm, P < 0.001. Mean nasolabial angle changed from 100.7 ± 5.33° to 98.2 ± 3.43°, P < 0.05. No implant extrusion was observed during the available follow-up period.
CONCLUSIONS: In selected primary Han Chinese patients, this hybrid ePTFE-auricular cartilage technique may be a useful option for dorsal augmentation, limited nasal lengthening, and tip refinement. The approach may help achieve aesthetic goals in mild cases without routine costal cartilage harvest. However, the findings should be interpreted within the context of a retrospective case series with a minimum 24-month follow-up, and longer follow-up is required to further evaluate delayed implant-related complications and the durability of aesthetic outcomes.
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