耳后局部三角瓣联合残耳软骨拼接在小耳畸形患儿全扩张法耳再造中的应用

Application of postauricular local triangular flap combined with residual ear cartilage splicing in total expansion method for pediatric ear reconstruction

摘要:

【摘要】目的 探讨在全扩张法耳再造术中，通过耳后局部三角瓣法重塑并加深耳颅角联合残耳软骨作为功能性填充材料，改善再造耳术后形态的临床效果。 方法 采用回顾性队列研究。将2020年1月至2025年1月收治的、在标准肋软骨雕刻基础上利用耳后局部三角瓣法联合残耳软骨拼接的25例小耳畸形患儿设为试验组（男17例，女8例，年龄6岁4月～14岁11月）。按年龄与性别行1:1倾向性评分匹配选取2020年1月至2025年1月由同一团队行手术、传统肋软骨堆叠法行耳再造的25例小耳畸形患儿作为对照组（男17例，女8例，年龄6岁11月～16岁）。采用SPSS26.0软件比较两组肋软骨切取量、术后形态稳定后（术后12-18个月）的再造耳形态学评分、家属满意度（VAS评分）及并发症。 结果 两组患儿在年龄、性别、畸形类型等基线指标上差异无统计学意义（P值均>0.05）。与对照组相比，试验组三维形态更优，精细结构显现度评分更高[（32.48±3.63）分 vs （29.64±2.06）分，P=0.002]；试验组满意度（家属满意度VAS评分）更高[（4.08±0.70） vs （3.60±0.71），P=0.017]。两组在对称度评分、取肋软骨数量、并发症发生率上差异无统计学意义（P值均>0.05）。 结论 在小耳畸形患儿全扩张法耳再造中，利用耳后三角瓣法联合残耳软骨拼接耳支架能有助于构建更明显的耳轮脚及三维立体感更好的耳廓，提升患者满意度，具有临床参考价值。

Abstract:

【Abstract】 Objective To explore, in expansion auricular reconstruction, the clinical effect of reshaping and deepening the auriculocephalic angle using the local postauricular triangular flap combined with remnant ear cartilage as functional filler to improve the postoperative morphology of reconstructed ears. Methods From January 2020 to January 2025, 25 children with microtia who received treatment using the postauricular local triangular flap combined with residual ear cartilage on the basis of standard costal cartilage carving were set as the experimental group (17 boys, 8 girls, aged 6 years 4 months to 14 years 11 months). Using 1:1 propensity score matching (PSM) based on age and gender, to select 25 children with microtia who underwent ear reconstruction using the traditional costal cartilage stacking method by the same team during the same period as the control group (17 boys, 8 girls, aged 6 years 11 months to 16 years). SPSS 26.0 software was used to compare the amount of costal cartilage harvested, the morphological scores of the reconstructed ears after postoperative shape stabilization (12–18 months postoperatively), family satisfaction (VAS score), and complications between the two groups. Results There were no statistically significant differences between the two groups of children in baseline indicators such as age, sex, and type of malformation (all P > 0.05). Compared with the control group, the experimental group had better three-dimensional morphology and higher fine structure visualization scores [(32.48 ± 3.63) vs (29.64 ± 2.06), P = 0.002]; the experimental group also had higher satisfaction (family satisfaction VAS score) [(4.08 ± 0.70) vs (3.60 ± 0.71), P = 0.017]. There were no statistically significant differences between the two groups in symmetry scores, number of harvested costal cartilages, or incidence of complications (all P > 0.05). Conclusion In expansion ear reconstruction for children with microtia, using the posterior auricular triangular flap method combined with residual ear cartilage to assemble the ear framework can help to create a more distinct auricular crus and an auricle with better three-dimensional stereoscopic sense, improving patient satisfaction and having clinical reference value.