- 期刊
使用內嵌自體骨片以矯正尾端鼻中隔彎曲－安全性與可行性之早期結果報告
The Safety and Feasibility of Interlocked Bone Graft for the Management of Caudal Septal Deviation
摘要
背景：鼻中隔成形手術是耳鼻喉科醫師最常執行的鼻部手術之一，而尾端鼻中隔彎曲則是鼻中隔矯正手術中較有難度的一個位置，手術不僅需要改善鼻塞，也需要維持鼻頭的支持以避免鼻變形。本研究的目的是提出一種將自體骨片以內嵌於軟骨中的方式來矯正尾端鼻中隔彎曲之技術，並探討其安全性及可行性。方法：本研究採回溯性病歷回顧，收集由2014年11月至2017年2月間，於基隆長庚醫院接受雙側下鼻甲部分切除術合併以內嵌自體骨片矯正尾端鼻中隔彎曲的病患。手術的適應症為慢性鼻塞，經診斷為尾端鼻中隔彎曲及下鼻甲增生，且經藥物治療無效之病患。本研究的主要結果是觀察病患在術後3個月內是否有鼻變形、鼻中隔穿孔、鼻中隔血腫、鼻中隔膿瘍、術後感染、嚴重術後出血、骨片脫出及嚴重異物感等狀況。次要結果則是以鼻塞問卷(Nasal Obstruction Septoplasty Effectiveness)，比較病患術前及術後3個月的分數，以評量手術效果。結果：共計納入12名病患，病患在術後3個月內並無發現鼻變形、鼻中隔穿孔、鼻中隔血腫、鼻中隔膿瘍、術後感染、嚴重術後出血、骨片脫出及嚴重異物感等併發症。在鼻塞問卷分數方面，術前與術後3個月之分數呈現明顯差異(p ＜ 0.001)。結論：使用內嵌自體骨片矯正尾端鼻中隔彎曲，是一種安全且可行的術式。此手術是由單純的鼻內徑路來進行尾端鼻中隔彎曲矯正，術中不須困難的鑽孔及縫合技術，也因此能減低手術難度和手術時間。此外，即使對於嚴重尾端鼻中隔彎曲，自體骨片也能提供足夠的強度來矯正彎曲之部位。
並列摘要
BACKGROUND: Correction of the deviated caudal septum is a challenging task because it is a nasal tip supporting structure. Here we describe an interlocked bone graft technique to correct caudal septal deviations and to evaluate the safety and surgical outcomes. METHODS: Twelve patients underwent an endonasal septoplasty using an interlocked bone graft to correct a deviated caudal septum. The primary outcome measures were postoperative adverse events. The secondary outcomes were improvements in nasal obstruction at 3 months after surgery. The Nasal Obstruction Septoplasty Effectiveness (NOSE) scale was the subjective measurement. RESULTS: No nasal deformity, septal perforation, septal hematoma, septal abscess, wound infection, severe bleeding, graft extrusion or foreign body sensation were observed during the follow-up period. The NOSE scores decreased from 72 (64-80) to 8 (0-32) ( p ＜ 0.001, Wilcoxon signed rank test). CONCLUSIONS: An interlocked bone graft can be used for the management of a deviated caudal septum and is a safe and effective technique. The technique could be an option for the management of caudal septal deviation.