鼻整形中韧带保留技术的临床进展

Clinical advances of ligament preservation techniques in rhinoplasty

摘要:

保留性鼻整形的理念已由骨-软骨支架的保留扩展至鼻部韧带与皮肤软组织罩的精细化处理。近年来，高分辨率MRI、三维重建及尸体解剖进一步阐明了卷轴韧带、皮坦基韧带、穹窿间韧带、梨状韧带等结构的空间解剖关系，及其在鼻尖支撑、鼻阀稳定和软组织轮廓维持中的作用。本文围绕鼻部韧带系统的解剖与影像学新认识，综述相关韧带的保留、松解、重置、修复和重建技术，并总结已报道的功能与美学结果。现有研究提示，依据个体解剖与手术目标选择性保留、松解或重建韧带，可能有助于改善鼻气道通畅度、优化鼻尖轮廓及促进软组织贴附，并减少术区无效腔，降低部分轮廓相关并发症的发生率。然而，不同鼻型、皮肤厚度及人种解剖差异决定了韧带处理策略不能一概而论。保留性鼻整形技术与结构性鼻整形技术相结合的混合式鼻整形，为兼顾自然形态、功能保护与稳定支撑提供了可行路径。未来仍需开展大样本、长期随访和客观功能评估的研究，以明确不同韧带处理方式的适应证及长期效果。

Abstract:

The concept of preservation rhinoplasty has evolved from maintaining the osseocartilaginous framework to meticulous management of the nasal ligaments and the skin and soft-tissue envelope. Recent high-resolution magnetic resonance imaging, three-dimensional reconstruction, and cadaveric studies have further clarified the spatial anatomical relationships among structures such as the scroll ligament, Pitanguy ligament, interdomal ligament, and pyriform ligament, as well as their roles in tip support, nasal valve stability, and soft-tissue contour maintenance. This article summarizes the latest anatomical and imaging insights into the nasal ligament system, reviews techniques for ligament preservation, release, repositioning, repair, and reconstruction, and compiles reported functional and aesthetic outcomes. Available evidences suggest that selective ligament preservation, release, or reconstruction based on individual anatomy and surgical goals may improve nasal airway patency, refine tip aesthetics, enhance soft tissue apposition, reduce dead space, and minimize certain contour-related complications. However, ligament management should be individualized according to nasal morphology, skin thickness, and population-specific anatomy. A hybrid rhinoplasty combining preservation and structural techniques offers a feasible approach to achieving natural appearance, functional protection, and stable support. Future research should focus on large-scale, long-term follow-up studies with objective functional assessments to define indications and long-term outcomes of different ligament management strategies.