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The Clinical Efficacy of Fat Injection on the Repair of Hand Flexor Tendon: A Randomized Clinical Trial. 脂肪注射对修复手部屈肌腱的临床疗效:随机临床试验
IF 0.9 Pub Date : 2023-01-01 DOI: 10.52547/wjps.12.2.41
Siamak Farokh Forghani, Hojjat Haghighimanesh, Tayyeb Ghadimi, Hossein Akbari, Hamidreza Farahmand, Soheila Naderi Gharahgheshlagh, Seyed Ehsan Mousavi-Lajimi

Background: In recent years, special attention has been paid to minimally invasive and conservative methods in addition to conventional surgical methods to repair tendon damage. In this regard, the effect of fat injection and graft has been of great interest due to its potential in accelerating tissue repair. We aimed to assess the clinical efficacy of fat injection along with conventional approach in patients with flexor tendon injury.

Methods: In this randomized clinical trial, 64 patients were randomly scheduled for tendon repair using the usual modified Kessler four-strand method alone or tendon repair using four-strand method and fat injection on the proximal and distal sides of the repair site in the Hazrat Fatemeh Hospital, Tehran Province, Iran in 2022 (IRCT20221206056723N1). Patients were followed-up for eight weeks regarding the function status of the repaired tendon (using Strickland grading test), range of motion (by physical examination) and flexion and extension gaps (by imaging).

Results: In the eighth weeks after the treatment, the average Strickland score was significantly higher in the group receiving fat injection (P: 0.009 ). In the two pointed times, the mean range of motion was significantly higher and the mean flexion and extension gaps were significantly lower in those who received fat injection. None of the procedural side effects were observed in the fifth and eighth weeks after the treatment.

Conclusion: Fat injection along with usual surgical treatment for tendon repair accelerates and improves tendon function and range of motion.

背景:近年来,除传统手术方法外,微创和保守方法也受到特别关注,以修复肌腱损伤。在这方面,脂肪注射和移植因其在加速组织修复方面的潜力而备受关注。我们的目的是评估脂肪注射和传统方法在屈肌腱损伤患者中的临床疗效:在这项随机临床试验中,伊朗德黑兰省 Hazrat Fatemeh 医院(IRCT20221206056723N1)于 2022 年随机安排了 64 名患者进行肌腱修复,修复方法包括单独使用通常的改良 Kessler 四股法,或使用四股法并在修复部位的近端和远端注射脂肪(IRCT20221206056723N1)。对患者进行了为期八周的随访,以了解修复肌腱的功能状况(使用斯特里克兰分级测试)、活动范围(通过体格检查)以及屈伸间隙(通过影像学检查):治疗后第八周,接受脂肪注射组的平均斯特里克兰德评分明显更高(P:0.009)。接受脂肪注射组的平均活动范围明显更大,平均屈伸间隙明显更小。治疗后第五周和第八周均未观察到手术副作用:结论:在肌腱修复的常规手术治疗的同时进行脂肪注射,可加快和改善肌腱的功能和活动范围。
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引用次数: 0
Pharmacological and Non-Pharmacological Methods of Postoperative Pain Control Following Oral and Maxillofacial Surgery: A Systematic Review. 口腔颌面外科术后疼痛控制的药物和非药物方法:系统综述。
IF 0.9 Pub Date : 2023-01-01 DOI: 10.52547/wjps.12.2.3
Amin Rahpeyma, Majid Eshghpour, Tooraj Vaezi, Shams Abdolrahim, Amir Manafi, Navid Manafi

Background: We aimed to investigate the pharmacological and non-pharmacological interventions used for mitigating pain.

Methods: We integrated randomized controlled trials (RCTs) chosen from PubMed, Google scholar, and Scopus and aimed at assessing the effectiveness of one or multiple variants of Non-steroidal anti-inflammatory drugs (NSAIDs), as well as Narcotic analgesics, compared to corticosteroids, curcumin, hyaluronic acid, and antibiotics. In addition, trials utilizing NSAIDs, including Rofecoxib, which have been withdrawn from market circulation, were deemed ineligible for inclusion.

Result: A total of 9 RCTs were evaluated in this study, and the patients' postoperative pain was assessed using the visual analog scale (VAS) and the time measurement. Moreover, there were various approaches to alleviating pain and discomfort.

Conclusion: The administration of ibuprofen prior to surgery leads to a marked reduction in pain. Pharmacological interventions, such as the administration of dexamethasone and oxycodone, alongside non-pharmacological interventions, such as laser therapy, have been shown to effectively alleviate the discomfort resulting from surgical procedures on the jaw and face.

背景:我们旨在调查用于减轻疼痛的药物和非药物干预措施:我们旨在调查用于减轻疼痛的药物和非药物干预措施:我们整合了从 PubMed、Google scholar 和 Scopus 选取的随机对照试验 (RCT),旨在评估非甾体抗炎药 (NSAID) 的一种或多种变体以及麻醉性镇痛药与皮质类固醇、姜黄素、透明质酸和抗生素相比的有效性。此外,使用非甾体抗炎药(包括已退出市场流通的罗非昔布)的试验被认为不符合纳入条件:结果:本研究共评估了 9 项 RCT,并使用视觉模拟量表(VAS)和时间测量法评估了患者的术后疼痛。此外,还有多种缓解疼痛和不适的方法:结论:术前服用布洛芬可明显减轻疼痛。药物干预(如地塞米松和羟考酮)和非药物干预(如激光治疗)已被证明能有效减轻颌面部手术带来的不适。
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引用次数: 0
Prevalence of Bifid Mandibular Canal: A Systematic Review and Meta-analysis. 下颌双叉管的患病率:系统回顾与元分析》。
IF 0.9 Pub Date : 2023-01-01 DOI: 10.52547/wjps.12.2.11
Sahand Samieirad, Mehdi Aryana, Ali Mazandarani, Iman Misagh Toupkanloo, Milad Eidi, Vahid Moqarabzadeh, Alireza Ebrahimpour, Touraj Vaezi

Objectives: The aim of this study was to evaluate the prevalence of bifid mandibular canal (BMC) using cone-beam computed tomography (CBCT) and panoramic images through meta-analysis.

Methods: Databases of Scopus, PubMed, and Web of Science were searched to find the relevant studies. Studies the met the inclusion criteria were selected. Variables of prevalence, side, length and diameter of BMC and sex were assessed. Data was analyzed using STATA software version 17.

Results: Of the 1164 articles initially selected, 36 were enrolled. A total of 38077 patients were considered. The overall prevalence of BMC was 18.0%. Studies that evaluated CBCT images reported higher prevalence of BMC compared to panoramic images (25.0% vs 3.0%). The prevalence of BMC was higher in men than women and slightly higher in right side than the left side of the jaw, but none of those differences were significant.

Conclusion: The results have shown a total prevalence of 18.0% for BMC. Detection power of CBCT images were higher than panoramics. There was no significant relation between prevalence of BMC with sex or side of the jaw.

研究目的本研究旨在通过荟萃分析,使用锥形束计算机断层扫描(CBCT)和全景图像评估下颌骨双叉管(BMC)的患病率:方法:检索 Scopus、PubMed 和 Web of Science 等数据库以查找相关研究。筛选出符合纳入标准的研究。评估变量包括患病率、侧位、BMC 长度和直径以及性别。数据使用 STATA 软件 17 版进行分析:在初步筛选出的 1164 篇文章中,有 36 篇被纳入。共考虑了 38077 名患者。BMC 的总患病率为 18.0%。评估 CBCT 图像的研究报告显示,与全景图像相比,BMC 的患病率更高(25.0% 对 3.0%)。男性的 BMC 患病率高于女性,颌骨右侧略高于左侧,但这些差异都不显著:结论:研究结果显示,BMC的总患病率为18.0%。CBCT 图像的检测能力高于全景图像。BMC的发病率与性别和颌面侧没有明显关系。
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引用次数: 0
Comparison of Craniosynostosis Surgery Outcomes Using Resorbable Plates and Screws versus Absorbable Sutures in Children with Craniosynostosis. 可吸收钢板螺钉与可吸收缝线治疗儿童颅缝闭手术疗效比较。
IF 0.9 Pub Date : 2023-01-01 DOI: 10.52547/wjps.12.1.37
Maryam Nobakht, Seyed Esmail Hasanpour

Background: Previously, absorbable screw and plate systems were widely used in craniosynostosis surgery in Iran, but now, due to the establishment of economic sanctions, the importation of these tools into the country has become difficult. In this study, we compared the short-term complications of cranioplasty surgery in craniosynostosis using absorbable plate screws with absorbable sutures.

Methods: In this cross-sectional study, 47 patients with a history of craniosynostosis who underwent cranioplasty at Tehran Mofid Hospital, Tehran, Iran from 2018 to 2021 were divided into two groups. For first group (31 patients) we used absorbable plate and screws, and for the second group (16 patients) absorbable sutures (PDS). All operations in both groups were performed by the identical surgical team. Patients followed up for consecutive post-operative examinations in the first and second weeks and 1, 3, and 6 months. Data were analyzed using SPSS software version 25.

Results: The results did not show any short-term or medium-term complications in either group. No recurrences were observed. In Whittaker classification, 63.8% were Class I, 29.8% were Class II, 6.4% were Class III, and 0% were Class IV. There was no statistically significant relationship between the type of treatment (screw and plate or absorbable suture) and higher Whitaker. There was also no statistically significant relationship between type of craniosynostosis and higher Whittaker.

Conclusion: The absorbable sutures can be considered as valuable and cost-effective tools in the fixation of bone fragments in craniosynostosis surgeries by surgeons.

背景:以前,可吸收螺钉和钢板系统在伊朗广泛用于颅缝闭锁手术,但现在,由于建立经济制裁,这些工具进口到该国变得困难。在本研究中,我们比较了采用可吸收钢板螺钉和可吸收缝线进行颅缝闭合颅骨成形术的短期并发症。方法:在这项横断面研究中,2018年至2021年在伊朗德黑兰Mofid医院接受颅骨成形术的47例有颅缝闭闭史的患者分为两组。第一组(31例)采用可吸收钢板螺钉,第二组(16例)采用可吸收缝线(PDS)。两组手术均由同一手术组完成。术后第1周、第2周、第1、3、6个月连续随访。数据分析采用SPSS软件25版。结果:两组患者均未出现中短期并发症。未见复发。Whittaker分类中,I类占63.8%,II类占29.8%,III类占6.4%,IV类占0%。治疗方式(螺钉钢板或可吸收缝线)与较高Whitaker评分无统计学意义。颅缝闭合类型与高惠特克评分之间也无统计学意义。结论:可吸收缝合线是外科医生在颅缝闭合术中固定骨碎片的一种有价值且性价比高的工具。
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引用次数: 0
Assessment of the Educational Environment of Plastic Surgery Training Programs in Iran using the PHEEM Questionnaire: A Cross-sectional Study. 使用 PHEEM 问卷评估伊朗整形外科培训项目的教育环境:横断面研究
IF 0.9 Pub Date : 2023-01-01 DOI: 10.52547/wjps.12.2.101
Zohreh Khoshgoftar, Soraya Shahrokh Shahraki, Shirin Araghi, Samaneh Tahmasebi Ghorabi, Golnaz Mahmoudvand, Arian Karimi Rouzbahani

Background: Clinical educational environments play a substantial role in the teaching of medical residents and fellows. In order to improve the quality of clinical education, its status should be evaluated. Therefore, we aimed to inquire about the educational environment of Plastic Surgery fellows in two teaching hospitals in Tehran, Iran using the Postgraduate Hospital Educational Environment Measure (PHEEM).

Method: In this descriptive cross-sectional study, Plastic Surgery fellows studying in two teaching hospitals in Tehran, Iran, in 2022 were included. The Persian version of the PHEEM questionnaire was applied for assessing the clinical educational environment. The collected data were analyzed by SPSS software version 22.

Results: Twenty six Plastic Surgery fellows were studied, 15.4% of whom were women (n=4) and 84.6% were men (n=22). The mean total score of the PHEEM questionnaire was 89.68±26.02. The highest mean score was in the teaching dimension (35.08), while the lowest mean score was in the social support dimension (25.42).

Conclusion: Most dissatisfaction among Plastic Surgery fellows were in the field of social support. It is necessary to adopt proper educational policies to improve the supportive resources for Plastic Surgery fellows.

背景:临床教育环境在住院医师和研究员的教学中发挥着重要作用。为了提高临床教育质量,应对其状况进行评估。因此,我们采用研究生医院教育环境测量法(PHEEM)调查伊朗德黑兰两家教学医院整形外科研究员的教育环境:在这项描述性横断面研究中,纳入了 2022 年在伊朗德黑兰两家教学医院学习的整形外科研究生。采用波斯语版 PHEEM 问卷对临床教学环境进行评估。收集的数据采用 SPSS 软件 22 版进行分析:研究对象中有 26 名整形外科研究员,其中女性占 15.4%(4 人),男性占 84.6%(22 人)。PHEEM 问卷的平均总分为 89.68±26.02。平均得分最高的是教学维度(35.08),平均得分最低的是社会支持维度(25.42):整形外科研究员最不满意的方面是社会支持。有必要采取适当的教育政策,改善整形外科研究员的支持资源。
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引用次数: 0
Electrodiagnostic Evaluation of Prognostic Factors Influencing the Surgical Outcomes of Upper Extremity Nerve Injuries Caused by Penetrating Trauma: A Cross-sectional Study. 影响穿透性创伤所致上肢神经损伤手术预后因素的电诊断评估:一项横断面研究。
IF 0.9 Pub Date : 2023-01-01 DOI: 10.52547/wjps.12.2.90
Amin Pahlavani, Nahid Hosseini Nejad Mir, Arian Karimi Rouzbahani, Golnaz Mahmoudvand, Pardis Rezaei, Ali Pahlevani, Mohammad Kazem Shahmoradi

Background: Peripheral nerve damage is a major cause of disability, which can lead to serious limitations in daily and occupational activities. Although primary repair can restore the function of the damaged organ remarkably, factors predicting the prognosis of nerve repair are a topic of constant debate. We aimed to investigate the factors affecting the outcomes of primary nerve repair in patients afflicted by upper extremity nerve injuries following penetrating trauma.

Methods: This cross-sectional study was conducted on 51 patients referred to Shohada-ye Ashayer Hospital in Khorramabad, Iran, from 2016 to 2021. Data including the patient's age, gender, education, type, severity, and mechanism of injury, the damaged nerve, time and of method repair, the surgeon's specialty, as well as the electrodiagnostic findings, were collected and analyzed using SPSS software version 22.

Results: The mean age of the patients was 30.41 ± 12.63 years, and the majority of them (84.3%) were men. A significant relationship was found between the sensory amplitude with education (P=0.002), the type of damaged nerve (P=0.048), and the severity of injury (P=0.012). The positive sharp wave was significantly associated with the surgeon's specialty (P=0.034). Besides, the motor amplitude was considerably related to the patient's age (P=0.040) and the surgeon's specialty (P=0.035).

Conclusion: Factors determining the outcome of peripheral nerve repair following penetrating trauma to the upper extremity include age, education, the type of damaged nerve, the severity of the injury, and the surgeon's specialty.

背景:周围神经损伤是致残的主要原因,可导致日常活动和职业活动严重受限。虽然原发性修复能显著恢复受损器官的功能,但预测神经修复预后的因素一直是一个争论不休的话题。我们旨在研究影响穿透性创伤后上肢神经损伤患者初次神经修复预后的因素:这项横断面研究的对象是 2016 年至 2021 年期间转诊至伊朗霍拉马堡 Shohada-ye Ashayer 医院的 51 名患者。收集的数据包括患者的年龄、性别、教育程度、损伤类型、严重程度和机制、受损神经、修复时间和方法、外科医生的专业以及电诊断结果,并使用 SPSS 软件 22 版进行分析:患者的平均年龄为(30.41±12.63)岁,大部分(84.3%)为男性。感觉振幅与教育程度(P=0.002)、受损神经类型(P=0.048)和损伤严重程度(P=0.012)有明显关系。锐波阳性与外科医生的专业明显相关(P=0.034)。此外,运动振幅与患者的年龄(P=0.040)和外科医生的专业(P=0.035)有很大关系:结论:决定上肢穿透性创伤后周围神经修复效果的因素包括年龄、教育程度、受损神经的类型、损伤的严重程度以及外科医生的专业。
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引用次数: 0
Evaluation of Clinical Manifestations, Pattern of Involvement, and Surgical Outcomes in Patients with Post Covid-19 Head and Neck Mucormycosis Infection among Patients Admitted To Namazi Hospital, Shiraz, Iran (2021-2022). 对伊朗设拉子市纳马济医院收治的 Covid-19 后头颈部黏菌血症感染患者的临床表现、感染模式和手术结果进行评估(2021-2022 年)。
IF 0.9 Pub Date : 2023-01-01 DOI: 10.61186/wjps.12.3.64
Mehryar Nahaei, Gholamreza Motazedian, Ali-Akbar Mohammadi, Mohammad Ali Davarpanah, Parsa Yazdanpanahi, Nazanin Ayareh, Fateme Salari, Alireza Keshtkar

Background: COVID-19, caused by SARS-CoV-2, is a global pandemic that particularly affects immunocompromised individuals, leading to secondary bacterial and fungal infections. Mucormycosis, caused by Mucorales fungi, is a severe infection primarily affecting immunocompromised individuals. The COVID-19 pandemic has seen a surge in mucormycosis cases worldwide, with India experiencing a significant increase. Various factors, including diabetes mellitus, contribute to the risk of mucormycosis. This study investigated head and neck mucormycosis in patients with prior COVID-19 infection.

Methods: Data from 45 patients were analyzed, with diabetes being the most common risk factor. Visual symptoms, ethmoid bone involvement, and orbital bone involvement were also identified as significant factors.

Results: The COVID-19 pandemic has led to an increase in mucormycosis cases, particularly in the head and neck region, with high mortality. Successful management involves addressing underlying factors, surgical debridement, and antifungal therapy.

Conclusion: Timely debridement reduces morbidity and mortality.

背景:由 SARS-CoV-2 引起的 COVID-19 是一种全球性流行病,尤其影响免疫力低下的人群,导致继发性细菌和真菌感染。由真菌粘孢子菌引起的粘孢子菌病是一种严重感染,主要影响免疫力低下的人群。在 COVID-19 大流行期间,全球粘孢子菌病病例激增,印度的病例显著增加。包括糖尿病在内的各种因素都会增加患粘孢子菌病的风险。本研究调查了曾感染COVID-19的患者的头颈部粘孢子菌病:分析了 45 名患者的数据,其中糖尿病是最常见的风险因素。视觉症状、蝶骨受累和眼眶骨受累也被认为是重要因素:COVID-19大流行导致粘孢子菌病病例增加,尤其是头颈部地区,死亡率很高。成功的治疗包括解决潜在因素、手术清创和抗真菌治疗:结论:及时清创可降低发病率和死亡率。
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引用次数: 0
Oral Isotretinoin Treatment in Rhinoplasty: A Review. 鼻整形术中的口服异维A酸治疗:综述。
IF 0.9 Pub Date : 2023-01-01 DOI: 10.61186/wjps.12.3.11
Mohamad Reza Afzalzadeh, Ali Alizadeh

The achievement of best outcome in rhinoplasty is very important for both of the patients and plastic surgeons. Since the skin characteristics (e.g. nasal thickness and sebaceous hypertrophy) has clear role on the result, many related interventions have been proposed in recent decades to gain an appropriate result. Accordingly, isotretinoin firstly introduced to treat some type of acne, has been suggested controversially to be used in rhinoplasty. Although the early uncertain studies implied on its side effects, the recent more powerful studies and evidences indicate that isotretinoin is remarkably effective to obtain proper outcome. Nevertheless, its prescription to patients need to be evaluated and personalized. More discussion on this regard are presented in the text.

实现鼻整形术的最佳效果对患者和整形外科医生来说都非常重要。由于皮肤特征(如鼻翼厚度和皮脂腺肥大)对手术效果有明显影响,近几十年来,人们提出了许多相关干预措施,以获得适当的手术效果。因此,异维A酸最初被用于治疗某种类型的痤疮,但也有人建议将其用于鼻整形术,这引起了争议。虽然早期的不确定研究暗示了其副作用,但最近更有力的研究和证据表明,异维A酸对获得适当的效果非常有效。尽管如此,仍需对患者的处方进行评估和个性化定制。文中将对此进行更多讨论。
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引用次数: 0
Medial Canthal Reconstruction - Scar Restricting Vision in Only Seeing Eye of a 75-year-old Female. 内侧眦重建术- 75岁女性单眼瘢痕限制视力。
IF 0.9 Pub Date : 2023-01-01 DOI: 10.52547/wjps.12.1.75
Aayush Sharma, Alexandros Georgolios

Scarring is a common post-injury outcome that can precipitate functional impairment. We present the case of a 75-year-old female who presented with diminished upper eyelid excursion in her right (only seeing) eye due to scarring associated with a facial laceration. She had a history of right eye corneal transplantation and necessitated urgent excision of the scar to release upper eyelid motion. The scar was excised, and a full-thickness skin graft (FTSG) was used, harvested from the skin of the right supraclavicular neck. Post-operative recovery was excellent, and the patient was relieved of restriction of her right upper eyelid opening.

瘢痕形成是一种常见的损伤后结果,可导致功能损害。我们提出的情况下,一个75岁的女性谁提出减少上眼睑偏移在她的右眼(只能看到)由于疤痕与面部撕裂伤相关。患者有右眼角膜移植史,需要紧急切除疤痕以解除上眼睑运动。切除瘢痕,采用全层皮肤移植(FTSG),取材于右侧锁骨上颈部皮肤。术后恢复良好,患者解除了右上睑开口的限制。
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引用次数: 0
Aesthetic and Functional Consequences of Spreader Graft without Suturing To the Upper Lateral Nasal Cartilage: A Randomized Double-Blinded Clinical Trial. 不缝合鼻翼上外侧软骨的扩张器移植的美学和功能效果:随机双盲临床试验。
IF 0.9 Pub Date : 2023-01-01 DOI: 10.61186/wjps.12.3.24
Seyed Esmail Hassanpour, Mohadeseh Amini, Abdolreza Rouientan

Background: Considering the importance of the spreader graft technique in order to prevent collapse and airway retention and the importance of its effect on the dorsal aesthetic line and nasal width, in this study we compared the outcome of suturing spreader graft to septum _upper lateral cartilageas the classic technique to suturing spreader graft only to septum.

Methods: This comparative observational study was conducted on 50 consecutive patients referred to Rhinoplasty Department in 15 khordad Hospital from 2019 - 2020 . The study participants were randomly assigned into two groups which scheduling the new spreader graft technique without suturing the upper lateral cartilage (n = 25) or the frequent spreader graft technique with suturing to both septum and upper lateral nasal cartilage (n = 25). The nasal obstruction degree, the status and health-related quality of life, patients' satisfaction, and subjective mental image of the nasal structure were the study endpoint. The patients were followed-up for six months.

Results: The two groups were matched for gender and age. Although all study endpoints significantly improved in both groups, but the six-month trend of the change in each parameter was different in the two groups with superior improvement in those who planned for spreader graft technique without suturing the upper lateral cartilage.

Conclusion: In patients scheduling for selective rhinoplasty, new procedural technique including spreader graft without suturing to upper lateral cartilage can lead to more postoperative favorable outcome with regard to patients' satisfaction of the procedure, lack of obstructive symptoms, aesthetic feature, and health-related quality of life as compared to suturing to both septum and upper lateral cartilage.

背景:考虑到扩张器移植技术对于防止塌陷和气道滞留的重要性,以及其对鼻背美学线和鼻腔宽度影响的重要性,在本研究中,我们比较了将扩张器移植缝合到鼻中隔_上外侧软骨作为经典技术与仅将扩张器移植缝合到鼻中隔的结果:这项比较观察研究是针对 2019-2020 年期间转诊到 15 khordad 医院鼻整形科的 50 名连续患者进行的。研究参与者被随机分配到两组,即不缝合鼻中隔上外侧软骨的新扩张器移植技术组(n = 25)或缝合鼻中隔和鼻外侧上软骨的频繁扩张器移植技术组(n = 25)。研究终点为鼻阻塞程度、生活状态和健康相关质量、患者满意度以及鼻腔结构的主观心理形象。对患者进行了为期 6 个月的随访:结果:两组患者的性别和年龄匹配。结果:两组患者的性别和年龄均相匹配,虽然两组患者的所有研究终点均有明显改善,但两组患者半年后各项参数的变化趋势不同,计划采用不缝合上外侧软骨的扩张器移植技术的患者的改善效果更好:结论:对于计划进行选择性鼻整形术的患者,与同时缝合鼻中隔和上外侧软骨相比,包括不缝合上外侧软骨的扩张器移植术在内的新手术技术可在患者对手术的满意度、无阻塞症状、美学特征和与健康相关的生活质量方面带来更有利的结果。
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引用次数: 0
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World Journal of Plastic Surgery
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