【作者】 陈宇；

【导师】 郑谦；

【作者基本信息】 四川大学 ， 口腔医学（专业学位）， 2022， 硕士

【摘要】 非综合征型单侧唇裂是较为常见的一种先天性面部畸形,目前治疗的主要方式是以手术治疗为主的多学科联合序列治疗。虽然,随着手术方法的不断改进,大多数患者都能够取得术后的静态对称,但继发的唇畸形,特别是唇对称性与立体感的不足始终是修复难点。为了更好的恢复唇对称性,并重建唇形立体感,我们发展了新的单侧唇裂术后唇部畸形的整复方法;肌肉平衡重建。该手术的核心是以肌肉的对称重建为基础,以获得相同长度的肌肉为方法,在重建口轮匝肌的同时,恢复患者的人中和唇珠的形态。为了评价该方法的术后效果,我们设计了如下实验:1.实验一,术后一周的对称效果的3D评价,共纳入2020年12月至2021年12月间的35名单侧唇裂术后继发唇部畸形的患者,于我院唇行“肌肉平衡重建”手术治疗。通过3D距离图来比较患者术前和术后一周上唇的对称性。该方法是将镜像后的3D图像和原始图像重叠在一起,测量选定区域内所有数据点上两个图像之间的距离,以此来比较两个图像之间的差异,差异越小,表明对称性越好。2.实验二,术后半年整复效果的综合评价,共纳入了 2019年6月至2021年12月间的42名单侧唇裂术后继发唇部畸形的患者,于我院行“肌肉平衡重建”手术治疗。使用患者的照片资料对唇高、侧唇宽、唇峰处红唇厚度和唇峰点至面中线距离这四个客观指标进行测量,同时使用五分制的量表进行医生美学评价和患者满意度评价。以此来比较患者术前、术后一周以及术后半年以上复诊时的上唇形态,对该手术方法的效果进行进一步的综合评价。经数据统计分析后,得到如下结果:实验一:与术前相比,术后一周患者上唇距离图的均方根(P=0.028)和标准差(P=0.027),均有明显的下降,说明术后上唇的对称性有了明显的改善。实验二:1)与术前相比,术后一周和术后半年的唇高、唇峰处红唇厚度以及唇峰点至面中线距离的不对称率均小于术前,差异有统计学意义(P<0.05);2)术后一周和术后半年的唇高、侧唇宽、唇峰处红唇厚度以及唇峰点至面中线距离的不对称率这四个测量指标之间均无统计学差异;3)医生美学评估和患者满意度评价各项指标平均得分均为4分以上。进一步分析后,得到如下结论:1.肌肉平衡重建二期整复单侧唇裂术后继发唇畸形,术后一周和术后半年均能够获得良好的效果,改善上唇的不对称。术后半年同行和患者的主观平价均较高;2.该手术方法的大部分术后效果可以在术后半年时间内维持稳定。但其侧唇宽的不对称存在着复发倾向。该手术方法为整复单侧唇裂术后继发唇畸形和重建口周肌力的平衡提供了新的方向,但术后效果还需要更长时间的追踪研究。更多还原

【Abstract】 The cleft lip and palate is one of the most common congenital facial deformities,and the main treatment modality at present is a multidisciplinary combined sequential treatment based on surgical treatment.The continuous improvements in surgical techniques have made it possible for most patients to achieve postoperative static symmetry,but a secondary deformity of the lip,especially the absence of lip symmetry and stereoscopic appearance,is always a difficult challenge to repair.With the goal of restoring symmetry and reconstructing stereoscopic appearance of the lip in secondary repair,we have developed a new method:muscle balance reconstruction.The key of this method is the symmetrical reconstruction of the muscles in order to obtain the same muscle length,while the patient’s philtral ridges,philtral dimples and vermilion tubercle are restored.To evaluate the postoperative results of this method,we performed the following experiment.1.In experiment one,3D evaluation of symmetry one week after operation,a total of 35 patients with secondary unilateral cleft lip deformity who were admitted to our center and treated with "muscle balance reconstruction" from December 2020 to December 2021 were included.A 3D distance map of the upper lip was created and the symmetry of the upper lip was compared before and after surgery in order to assess the short-term results.The difference was measured by overlaying the mirrored 3D image with the original image and measuring the distance between them at all data points in the selected area.The smaller the difference,the better the symmetry is indicated.2.In experiment two,A total of 42 patients with secondary unilateral cleft lip deformity who were admitted to our center and treated with "muscle balance reconstruction" from June 2019 to December 2021 were included.Four objective indicators,namely lip height,lateral lip width,vertical distance from the white roll to the vermilion bottom at the Cupid’s bow point,and vertical distance from the Cupid’s bow points to facial midline,were measured using the patients’ photographic data,and two subjective indicators,namely aesthetic outcome and patient and family satisfaction,were evaluated.The morphology of the upper lip was compared before,one week after,and six months after surgery to evaluate the comprehensive effects of this surgical method.After statistical analysis of the data,the following results were obtained:In experiment one:There was a statistically significant decrease in the root mean square(P=0.028)and standard deviation(P=0.027)of the 3D image distance map of the patient one week after surgery compared with the preoperative period,indicating that the symmetry of the upper lip has improved significantly after operation.In experiment two:1)Compared with the pre-operation,the asymmetry rate of the lip height,the vertical distance from the white roll to the vermilion bottom at the Cupid’s bow point,and the vertical distance from the Cupid’s bow points to facial midline were significantly reduced one week and six months after operation.(P<0.05)2)Compared with the results one week after surgery,the asymmetry rate of the lip height,the lateral lip width,the vertical distance from the white roll to the vermilion bottom at the Cupid’s bow point,and the vertical distance from the Cupid’s bow points to facial midline six months after surgery were not statistically different.3)The mean scores of each index of the physician aesthetic assessment and patient satisfaction evaluation were at least 4.After further analysis,the following conclusions were obtained:1.Muscle symmetry reconstruction to rectify the secondary lip deformity was able to obtain good results and improve the asymmetry of the upper lip one week and six months after surgery.Subjectively,the results of this surgical method at six months postoperatively can be recognized by peers and patients.2.Most of the postoperative results of this surgical method can be maintained stable for six months postoperatively.However,the asymmetry of its lateral lip width has a tendency of recurrence.In conclusion,this surgical approach provides a creative idea for the correction of secondary deformity of unilateral cleft lip and the restoration of perioral muscle balance.However,a more prolonged follow-up study of postoperative results is needed.更多还原