低位条带保留式鼻整形术中预防奶酪丝样畸形和鼻背驼峰复发

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中文摘要

背景： 鼻背驼峰复发是保留式鼻整形术的一种潜在并发症。在低位鼻中隔条带技术中，方形软骨作为旋转推进皮瓣锚定于前鼻棘。正确的固定对于防止因皮瓣向后旋转导致的驼峰复发至关重要。
方法： 回顾性分析2021年1月至2023年12月期间由同一位外科医生采用低位鼻中隔条带鼻中隔成形术进行的所有初次保留式鼻整形术，比较传统褥式缝合固定与一种称为风筝固定的新技术。主要结局变量为鼻背驼峰复发是否存在以及是否需要翻修手术。
结果： 共纳入823例患者，其中传统固定组405例，风筝形固定组418例。两组人口学特征相当。在驼峰复发（4.6% vs 1.2%）和翻修手术必要性（4.3% vs 1.1%）方面观察到统计学显著差异。
结论： 鼻背驼峰复发和小驼峰仍是保留式鼻整形术的重要缺陷。旋转鼻中隔皮瓣的正确固定对于实现术后长期稳定性至关重要。将缝合环的张力重新分布为三角形构型，即风筝形方法，已被证明是一种简单、有效且可重复的技术。

英文摘要

BACKGROUND: Hump recurrence represents a potential complication of preservation rhinoplasty. In the low septal strip technique, the quadrangular cartilage functions as a rotational advancement flap anchored to the anterior nasal spine. Proper fixation is crucial to prevent hump recurrence caused by backward rotation of the flap.
METHODS: All primary preservation rhinoplasties performed by the same surgeon with the low septal strip septoplasty technique between January of 2021 and December of 2023 were analyzed retrospectively, comparing conventional fixation with mattress sutures to a novel technique, referred to as kite fixation. The primary outcome variables were the presence or absence of hump recurrence and the need for revision surgery.
RESULTS: A total of 823 patients were included in the study, with 405 in the conventional fixation group and 418 in the kite-shaped fixation group. Demographic characteristics were comparable between the groups. Statistically significant differences were observed in terms of hump recurrence (4.6% versus 1.2%) and the necessity of revision surgery (4.3% versus 1.1%).
CONCLUSIONS: Hump recurrence and minihumps remain significant drawbacks in preservation rhinoplasty. Proper fixation of the rotated septal flap is crucial to achieving long-term postoperative stability. Redistributing the tension of the suture loops into a triangular configuration, known as the kite-shaped method, has proven to be a simple, effective, and reproducible technique.