A Comparison of Costal Cartilage Warping Using Oblique Split vs Concentric Carving Methods
A Comparison of Costal Cartilage Warping Using Oblique Split vs Concentric Carving Methods
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DOI：
10.1001/jamafacial.2017.0163
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发表时间：
2017-11-01
影响因子：
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通讯作者：
Faris, Callum
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文献类型：
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作者：
Wilson, Gemma C.;Dias, Laura;Faris, Callum
肋软骨的重要翘曲被很好地描述，然而，它的强度和丰富仍然使它成为理想的移植材料，特别是在复杂的重建鼻整形术中。尽管多年来开发了多种软骨采集、雕刻和植入前处理方法，但WARP仍然是一个具有挑战性的临床问题。目的评估30度斜切法制备肋软骨移植物是否比目前使用同心切割法获取肋骨中央段的标准更少的移植物翘曲。设计、设置和参与者这项体外身体研究评估了从2014年12月开始的3个月期间，采用30度斜裂切割法和同心切割法移植肋软骨的翘曲。结果和测量结果与测量毫米的基线(在基线(1小时)，1，2，和3个月，3个月结果74例肋软骨移植(采用30°斜劈法41例，同心切割法33例)，斜切组的额面翘曲量平均为1.12 mm(95%CI，0.96~1.28 mm)~1.57 mm(95%CI，0.94~2.20 mm)，斜切组为1.18 mm(95%CI，0.98~1.38 mm)~1.29 mm(95%CI，0.86-1.72 mm)用于3个月期间的同心组。两种方法在1小时(P=0.45；0.10 mm，95%CI，-0.38~0.17 mm)、1个月(P=.32；0.13 mm，95%CI，-0.13~0.40 mm)、2个月(P=.50；0.28 mm，95%CI，-0.55~1.11 mm)或3个月(P=.15；0.22 mm，95%CI，-0.08至0.52 mm)，使用t检验、回归分析或面板数据分析。1个月(P=0.82；0.07 mm，95%CI，-0.56~0.70 mm)、2个月(P=0.29；0.40 mm，95%CI，-0.36~1.17 mm)或3个月(P=0.63；0.22 mm，95%CI，-0.70~1.13 mm)。结论与相关性：肋软骨移植30度斜切法与同心雕刻法在翘曲程度上是相当的。斜劈法可能更好，因为它更容易雕刻，材料体积更大。
IMPORTANCE Warping of costal cartilage is well described; however, its strength and abundance still make it a desirable graft material, especially in complex reconstructive rhinoplasty. Despite multiple methods of cartilage harvest, carving, and preimplantation treatment being developed over the years, warp remains a challenging clinical problem.OBJECTIVE To assess whether the 30 degrees oblique split method of preparing costal cartilage grafts produces less warping of the graft than the current standard of harvesting the central segment of a rib using the concentric carving method.DESIGN, SETTING, AND PARTICIPANTS This in vitro cadaveric study evaluated the warping of costal cartilage grafts using the oblique split method with an angle of 30 degrees or the concentric carving method during a 3-month period beginning in December 2014.MAIN OUTCOMES AND MEASURES Millimeters of warp from baseline (at 1hour) and at 1, 2, and 3 months, measured in the frontal and lateral planes.RESULTS Among 74 costal cartilage grafts (using the oblique split method with an angle of 30 in 41 and the concentric carving method in 33), the mean amount of warp in the frontal plane was between 1.12 mm (95% CI, 0.96-1.28 mm) and 1.57 mm (95% CI, 0.94-2.20 mm) for the oblique group and between 1.18 mm (95% CI, 0.98-1.38 mm) and 1.29 mm (95% CI, 0.86-1.72 mm) for the concentric group during the 3-month period. There was no statistically significant difference in the frontal plane between the 2 methods at 1 hour (P = .45; 0.10 mm, 95% CI, -0.38 to 0.17 mm), 1 month (P = .32; 0.13 mm, 95% CI, -0.13 to 0.40 mm), 2 months (P = .50; 0.28 mm, 95% CI, -0.55 to 1.11 mm), or 3 months (P = .15; 0.22 mm, 95% CI, -0.08 to 0.52 mm) using the t test, regression analysis, or panel data analysis. Similarly, no significant difference was found in the lateral plane at 1 hour (P = .89; 0.04 mm, 95% CI, -0.49 to 0.56 mm), 1 month (P = .82; 0.07 mm, 95% CI, -0.56 to 0.70 mm), 2 months (P = .29; 0.40 mm, 95% CI, -0.36 to 1.17 mm), or 3 months (P = .63; 0.22 mm, 95% CI, -0.70 to 1.13 mm) using the t test. Two grafts were excluded due to desiccation.CONCLUSIONS AND RELEVANCE The 30 degrees oblique split and concentric carving methods of costal cartilage graft carving are equivalent in terms of the amount of warp. The oblique split method may be superior because of easier carving and the increased volume of material.