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先天性唇裂是一种常见的口腔颌面部畸形,我国发病率为1.66%~1.82%,其发病原因尚不完全明确,据报道[1]多由基因和环境因素共同作用所致。其畸形表现多样,单侧Ⅲ度唇裂为其中一种,从外观看主要表现为单侧唇及鼻基底的裂隙,包括鼻唇正常结构的发育畸形和偏移,因其常伴有牙槽的错位及上颚裂隙的问题,故手术的难度及不确定性均较大。单纯唇裂修复手术的中心思想为打断鼻唇部原有的异常解剖结构,重建其肌肉的连续性,从而建立正常的解剖结构、功能以及提高鼻唇部对称性[2-3]。近年来,因传统Millard术式对Ⅲ度唇裂修复的局限性,从而衍生出各种改良术式,本研究以改良Millard术式为手术方法对单侧Ⅲ度唇裂进行修复, 并以几何学原理评估其修复效果及稳定性。现作报道。
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40例患儿术前的鼻翼点(A)、鼻翼基部点(B)、唇峰点(C)、口角点(D)的健侧坐标点面积均小于患侧(P < 0.01),术后1周时,B点的健、患侧坐标面积差异均无统计学意义(P>0.05),A、C、D点健侧面积仍小于患侧(P < 0.01)(见表 1)。
位置 n A点 B点 C点 D点 T1 T2 T1 T2 T1 T2 T1 T2 健侧 40 238.53±8.94 231.14±8.62 201.55±11.84 177.25±6.89 281.2±24.40 145.16±8.01 571.04±26.70 508.00±20.04 患侧 40 276.70±12.32 254.25±9.14 255.52±14.25 180.67±10.12 329.07±14.30 154.97±14.32 632.17±31.42 533.69±27.10 t — 19.19 11.26 20.95 1.74 9.97 3.80 9.30 5.56 P — < 0.01 < 0.01 < 0.01 >0.05 < 0.01 < 0.01 < 0.01 < 0.01 表 1 术前、术后1周面部健、患侧各测量点坐标面积比较(x ± s; mm2)
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因疫情等因素影响,最终选取21例患儿进行比较,以下21例患儿的术前和术后1周的二维对比结果(见表 2)与此前以40例患儿为样本来源时结果一致。21例患儿术前的A、B、C、D的健侧坐标点面积均小于患侧(P < 0.01);术后1周时,B点的健、患侧坐标面积差异无统计学意义(P>0.05),A、C、D点健侧面积仍小于患侧(P < 0.01);术后1年,B、C、D点健、患侧差异无统计学意义(P>0.05),仅A点健侧面积仍小于患侧(P < 0.01)(见表 2)。
位置 A点 B点 T1 T2 T3 T1 T2 T3 健侧 240.23±6.12 233.51±8.33 246.63±12.36 197.54±7.66 178.11±5.49 188.52±7.79 患侧 273.46±8.38 256.66±5.12 260.42±8.71 253.31±10.27 181.67±9.32 192.43±10.06 t 13.94 9.92 4.29 17.78 1.46 1.38 P < 0.01 < 0.01 < 0.01 < 0.01 >0.05 >0.05 位置 C点 D点 T1 T2 T3 T1 T2 T3 健侧 282.97±18.37 144.70±10.41 152.37±8.16 586.67±16.72 516.32±17.44 551.66±20.04 患侧 331.58±11.09 151.96±9.56 154.41±9.33 639.55±22.48 545.69±19.80 560.17±17.10 t 10.40 2.14 1.12 8.80 5.25 1.53 P < 0.01 < 0.05 >0.05 < 0.01 < 0.01 >0.05 表 2 术前、术后1周、及术后1年面部健、患侧各测量点坐标面积比较(x ± s;mm2)
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21例患儿术后1周和术后1年健、患侧各测量点对称率均高于术前(P < 0.01),术后1年的A点和D点的对称率高于术后1周(P < 0.01)(见图 2、3、表 3)。
测量点 n 对称率 F P MS组内 T1 T2 T3 A点 21 86.20±1.03 90.98±0.91** 94.70±0.77**△△ 504.03 < 0.01 13.777 B点 21 78.87±2.26 98.04±0.37** 97.97±0.46** 1 316.56 < 0.01 88.671 C点 21 85.45±3.74 95.22±1.03** 95.58±0.86** 128.44 < 0.01 28.863 D点 21 90.33±3.48 94.61±1.31** 96.69±0.72**△△ 53.24 < 0.01 12.319 注:与T1时比较*P<0.05, **P<0.01;与T2时比较△P<0.05, △△P< 0.01 表 3 术前、术后1周及术后1年面部各测量点对称率比较[x ± s;百分率(%)]
运用几何学原理评估改良Millard法对单侧Ⅲ度唇裂的修复效果
Study on the effects of modified Millard′s method in the reconstruction of unilateral degree Ⅲ cleft lip evaluated by geometric principles
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摘要:
目的评估改良Millard法修复单侧Ⅲ度唇裂术后唇鼻畸形改善情况及其稳定性。 方法选取自2018年10月至2020年7月就诊的单侧Ⅲ度唇裂患儿40例,采用改良Millard法进行唇裂修复。按照同一标准将患儿术前、术后1周及术后1年作为时间点进行照片采集。对所采集照片以同一标准进行坐标系的构建。健、患侧的鼻翼点(A)、鼻翼基部点(B)、唇峰点(C)及口角点(D)进行定位测量。计算各测量点坐标面积及对称率。比较各时间点健、患两侧面积差异;评估对称率随时间的整体变化情况;分析两两时间点之间的对称率变化情况,以评估手术改善情况及稳定性。 结果健、患侧坐标面积之间比较,术前A、B、C、D点健、患侧差异较大(P < 0.01)。经改良Millard法手术修复,于术后1周时,A、C、D点差异仍有统计学意义(P < 0.01),仅B点两侧差异无统计学意义(P>0.05)。术后1年时,A点两侧差异有统计学意义(P < 0.01),但B、C、D点两侧差异无统计学意义(P>0.05)。在比较对称率的变化时发现,术后1周和术后1年各测量点对称率均高于术前(P < 0.01),术后1年的A和D点的对称率高于术后1周(P < 0.01)。 结论运用改良Millard法修复单侧Ⅲ度唇裂,唇鼻畸形改善明显,对称性改善较好且具有良好的稳定性。 -
关键词:
- 唇裂 /
- 改良Millard法 /
- 对称率
Abstract:ObjectiveTo evaluate the improvement and stability of the modified Millard′s method in the reconstruction of lip-nasal deformity after unilateral degree Ⅲ cleft lip surgery. Methods Forty children with unilateral degree Ⅲ cleft lip treated with the modified Millard′s method from October 2018 to July 2020 were investigated.According to the same standard, the photos were collected before surgery, after 1 week and 1 year of operation.The coordinate system was constructed according to the same standard for the photos collected, the alar point(A), alar base point(B), lip peak point(C) and front cut point(D) of the healthy and affected sides were measured, and the coordinate area and symmetry rate of each measuring point were calculated.The difference analysis was made by comparing the area of healthy and affected sides at each time point, the overall change of symmetry rate over time was evaluated and the changes of symmetry rate between two time points were analyzed to assess the surgical improvement and stability. ResultsThe differences of the coordinate area at A, B, C and D points between the healthy side and affected side before operation were statistically significant(P < 0.01).After the modified Millard′s method surgery, the differences of the A, C and D points between the healthy side and affected side after 1 week of operation were statistically significant(P < 0.01), and the difference of which in B point was not statistically significant(P>0.05).After 1 year of operation, the difference of the coordinate area at A point between the healthy side and affected side was statistically significant(P < 0.01), but the differences of which at B, C and D points were not statistically significant(P>0.05).The symmetry rate of each measurement point after 1 week and 1 year of operation was higher than that before surgery(P < 0.01), and the symmetry rates of A and D points after 1 year of operation were higher than that after 1 week of operation(P < 0.01). ConclusionsThe modified Millard′s method in the reconstruction of unilateral degree Ⅲ cleft lip can significantly improve the lip-nasal deformity, and make the symmetry and stability better. -
Key words:
- cleft lip /
- modified Millard′s method /
- symmetry rate
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表 1 术前、术后1周面部健、患侧各测量点坐标面积比较(x ± s; mm2)
位置 n A点 B点 C点 D点 T1 T2 T1 T2 T1 T2 T1 T2 健侧 40 238.53±8.94 231.14±8.62 201.55±11.84 177.25±6.89 281.2±24.40 145.16±8.01 571.04±26.70 508.00±20.04 患侧 40 276.70±12.32 254.25±9.14 255.52±14.25 180.67±10.12 329.07±14.30 154.97±14.32 632.17±31.42 533.69±27.10 t — 19.19 11.26 20.95 1.74 9.97 3.80 9.30 5.56 P — < 0.01 < 0.01 < 0.01 >0.05 < 0.01 < 0.01 < 0.01 < 0.01 表 2 术前、术后1周、及术后1年面部健、患侧各测量点坐标面积比较(x ± s;mm2)
位置 A点 B点 T1 T2 T3 T1 T2 T3 健侧 240.23±6.12 233.51±8.33 246.63±12.36 197.54±7.66 178.11±5.49 188.52±7.79 患侧 273.46±8.38 256.66±5.12 260.42±8.71 253.31±10.27 181.67±9.32 192.43±10.06 t 13.94 9.92 4.29 17.78 1.46 1.38 P < 0.01 < 0.01 < 0.01 < 0.01 >0.05 >0.05 位置 C点 D点 T1 T2 T3 T1 T2 T3 健侧 282.97±18.37 144.70±10.41 152.37±8.16 586.67±16.72 516.32±17.44 551.66±20.04 患侧 331.58±11.09 151.96±9.56 154.41±9.33 639.55±22.48 545.69±19.80 560.17±17.10 t 10.40 2.14 1.12 8.80 5.25 1.53 P < 0.01 < 0.05 >0.05 < 0.01 < 0.01 >0.05 表 3 术前、术后1周及术后1年面部各测量点对称率比较[x ± s;百分率(%)]
测量点 n 对称率 F P MS组内 T1 T2 T3 A点 21 86.20±1.03 90.98±0.91** 94.70±0.77**△△ 504.03 < 0.01 13.777 B点 21 78.87±2.26 98.04±0.37** 97.97±0.46** 1 316.56 < 0.01 88.671 C点 21 85.45±3.74 95.22±1.03** 95.58±0.86** 128.44 < 0.01 28.863 D点 21 90.33±3.48 94.61±1.31** 96.69±0.72**△△ 53.24 < 0.01 12.319 注:与T1时比较*P<0.05, **P<0.01;与T2时比较△P<0.05, △△P< 0.01 -
[1] 马坚, 胡晨, 翟堃, 等. 宁夏1 482例先天性唇腭裂特征分析[J]. 宁夏医科大学学报, 2019, 41(10): 1042. [2] 李海鹏, 王予江, 宁文杰, 等. 单侧完全性唇裂鼻底修复的临床研究进展[J]. 国际口腔医学杂志, 2016, 43(1): 95. [3] 李承浩, 李业平, 石冰. 唇裂鼻畸形整复核心问题之华西观点[J]. 国际口腔医学杂志, 2019, 46(4): 383. [4] ALTU AT. Presurgical nasoalveolar molding of bilateral cleft lip and palate infants: an orthodontist′s point of view [J]. Turk J Orthod, 2017, 30(4): 118. doi: 10.5152/TurkJOrthod.2017.17045 [5] FARKAS LG. Anthropometry of the head and face[J]. Ann Occupat Hyg, 1994, 52(4): 773. [6] 李怡君. 改良Tennison-Randall术式在单侧唇裂患者中的应用及其术后效果评价[D]. 重庆: 重庆医科大学, 2018. [7] 方绍伟, 池朝玲, 朱光辉. 改良Tajima切口修复单侧唇裂术后继发鼻畸形[J]. 解放军预防医学杂志, 2017, 35(5): 474. [8] 高廷益, 张凯, 杨东昆, 等. 两种改良Millard法修复单侧唇裂的临床对比效果观察[J]. 口腔医学, 2017, 37(12): 1095. [9] 董文. 改良Millard法修复单侧完全性唇裂术后鼻部对称性的变化[D]. 银川: 宁夏医科大学, 2015. [10] GASSLING V, KOOS B, BIRKENFELD F, et al. Secondary cleft nose rhinoplasty: subjective and objective outcome evaluation[J]. Craniomaxillofac Surg, 2015, 43(9): 1855. doi: 10.1016/j.jcms.2015.08.012 [11] SUN BC, COU YN, JI LL, et al. Analysis of the clinical effect of 3 years after rhinoplasty in children with unilateral complete cleft lip and palate[J]. Chin J Pract Stomatol, 2016, 9(2): 93. [12] 张楠. 正畸掩饰性治疗对唇线倾斜的改善[D]. 重庆: 重庆医科大学, 2020. [13] 李一颖, 杨学财, 侯志军, 等. 口腔黏膜瓣用于非综合征型单侧完全性唇裂鼻底修复的效果评价[J]. 中国口腔颌面外科杂志, 2018, 16(5): 425. [14] LI YP, LIU RK, SHI B, et al. A new photogrammetry of nasal morphology for asian patients with unilateral secondary cleft lip nasal deformity[J]. Plast Reconstr Surg, 2019, 143(1): 244e. doi: 10.1097/PRS.0000000000005150 [15] PHILLIPS GSA, SWAN MC, SAWYER AR, et al. A Comparative study of the aesthetic outcome of two techniques for unilateral complete cleft lip repair[J]. Plast Reconstr Surg, 2017, 140(4): 757. doi: 10.1097/PRS.0000000000003685 [16] KUNA SK, SRINATH N, NAVEEN BS, et al. Comparison of outcome of modified millard's incision and delaire's functional method in primary repair of unilateral cleft lip: a prospective study[J]. J Maxillofac Oral Surg, 2016, 15(2): 221. doi: 10.1007/s12663-015-0816-z [17] 尹宁北. 中国式功能性唇裂修复术[J]. 中华口腔医学杂志, 2017, 52(4): 212. doi: 10.3760/cma.j.issn.1002-0098.2017.04.004 [18] 段志红, 徐静, 叶广春, 等. 改良Millard法结合鼻唇肌肉功能重建修复单侧唇裂21例[J]. 中国美容医学, 2020, 29(3): 75. [19] 叶广春, 李光早, 沈嬿, 等. 单侧完全性唇裂鼻唇特征的测量研究[J]. 中华全科医学, 2019, 17(6): 936. [20] 宋佳睿, 范飞. 面裂鼻畸形病因及临床诊疗的研究进展[J]. 医学综述, 2019, 25(10): 1975. doi: 10.3969/j.issn.1006-2084.2019.10.020 [21] 叶向阳, 邱林, 田晓菲, 等. 改良术式在单侧不完全性唇裂整复治疗的应用[J]. 重庆医科大学学报, 2016, 41(12): 1303. [22] 梁丽. 0-12岁汉族正常人群鼻腔形态及鼻唇发育的研究[D]. 重庆: 重庆医科大学, 2013. [23] 宋培军, 李建成, 张莉, 等. 改良Millard法修复单侧唇裂64例[J]. 实用医学杂志, 2017, 33(11): 1802. doi: 10.3969/j.issn.1006-5725.2017.11.021