动态而稳定的鼻尖：保留自然排列与鼻尖下转折的双柱内侧脚加固技术在亚洲人鼻整形中的应用

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中文摘要

背景： 亚洲人鼻整形常需要额外的鼻尖支撑，因为内侧脚往往薄弱、短小或不对称。尽管鼻中隔延伸移植物可提供强有力的支撑，但刚性固定可能降低鼻尖的生理性活动度并消除鼻尖下转折。我们描述双柱内侧脚加固技术，该技术在加强每个内侧脚的同时保留其原有轮廓。方法：对2023年至2025年间接受治疗的42例亚洲鼻整形患者进行了回顾性 review。该技术用于鼻尖突出度不足（Goode比<0.55）、内侧脚薄弱或不对称、以及希望保留动态鼻尖活动度的患者。将薄软骨移植物（0.8-2.0 mm）分别塑形并沿每个内侧脚固定，作为成对的双侧加固，使用间断5-0聚二氧环己酮缝线，而不进行刚性鼻中隔耦合。结局包括Goode比、鼻尖下转折角、鼻尖活动度（实用的4点临床分级）和患者满意度。结果：平均Goode比从0.51 ± 0.03改善至0.58 ± 0.02（P < 0.001），平均鼻尖下转折角从139 ± 7度改善至118 ± 5度（P < 0.001）。38例（90%）患者观察到3级生理性鼻尖活动度，而4例（10%）患者表现为2级活动度。平均患者满意度在10点视觉模拟量表上为8.7 ± 0.9。未发生需要修复的并发症。结论：双柱技术为内侧脚提供结构性加固，而不改变其原有形状。通过保留自然轮廓、鼻尖下转折和动态鼻尖活动度，它为亚洲人鼻整形中更刚性的鼻尖支撑技术提供了一种有用的替代或辅助方法。

英文摘要

Asian rhinoplasty often requires additional tip support because the medial crura are frequently weak, short, or asymmetrical. Although septal extension grafts provide strong support, rigid fixation may reduce physiological tip mobility and efface the infratip break. We describe the dual-pillar medial crural reinforcement technique, which strengthens each medial crus while preserving its native contour. A retrospective review was performed of 42 Asian rhinoplasty patients treated between 2023 and 2025. The technique was used in patients with inadequate tip projection (Goode ratio <0.55), weak or asymmetrical medial crura, and a preference for preserving dynamic tip mobility. Thin cartilage grafts (0.8-2.0 mm) were individually shaped and secured along each medial crus as paired bilateral reinforcement with interrupted 5-0 polydioxanone sutures without rigid septal coupling. Outcomes included Goode ratio, infratip break angle, tip mobility (pragmatic 4-point clinical grading), and patient satisfaction. Mean Goode ratio improved from 0.51 ± 0.03 to 0.58 ± 0.02 (P < 0.001), and mean infratip break angle improved from 139 ± 7 to 118 ± 5 degrees (P < 0.001). Grade 3 physiological tip mobility was observed in 38 (90%) patients, whereas 4 (10%) patients showed grade 2 mobility. Mean patient satisfaction was 8.7 ± 0.9 on a 10-point visual analog scale. No complications requiring revision occurred. The dual-pillar technique provides structural reinforcement of the medial crura without changing their native shape. By preserving natural contour, infratip break, and dynamic tip mobility, it offers a useful alternative or adjunct to more rigid tip-support techniques in Asian rhinoplasty.