国际口腔医学杂志

国际口腔医学杂志 ›› 2019, Vol. 46 ›› Issue (4): 407-412.doi: 10.7518/gjkq.2019038

• 论著 • 上一篇    下一篇

影响单侧唇裂鼻畸形二期整复主观评价结果的鼻测量指标探究

李业平,郑谦,尹恒,郭春丽,石冰,李承浩()   

  1. 口腔疾病研究国家重点实验室 国家口腔疾病临床医学研究中心 四川大学华西口腔医院唇腭裂外科 成都 610041
  • 收稿日期:2018-10-09 修回日期:2019-04-20 出版日期:2019-07-01 发布日期:2019-07-12
  • 作者简介:李业平,住院医师,博士,Email： darpingvip@163.com
  • 基金资助:
    四川大学创新火花项目(2018SCUH0028)

Exploration on nasal objective measurements affecting subjective evaluation of the secondary reconstruction of unilateral cleft lip nasal deformity

Li Yeping,Zheng Qian,Yin Heng,Guo Chunli,Shi Bing,Li Chenghao()   

  1. State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
  • Received:2018-10-09 Revised:2019-04-20 Online:2019-07-01 Published:2019-07-12
  • Supported by:
    This study was supported by Innovative Spark Project of Sichuan University(2018SCUH0028)

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摘要：

目的 为了明确影响主观评价单侧唇裂鼻畸形二期整复效果的客观测量指标,进一步改善唇裂鼻畸形整复的治疗水平。方法 选取实施过单侧唇裂鼻畸形二期整复患者80名,一方面通过评价者采用Asher-Mcdade主观评价体系对其仰位照片中鼻外形进行5分制评价;另一方面通过仰位照片的客观测量记录每名患者的鼻外形参数。利用多水平模型分析,探究主观评价结果和客观测量参数间的相关性。结果 多水平模型分析结果显示：在鼻部5个区域内的测量参数中,仅有鼻尖处参数和鼻小柱长度参数在不同主观评价等级间的差异均具有统计学意义。结论 鼻尖偏斜参数和鼻小柱长度参数可作为主观评价等级的预测性指标,而术后鼻翼外凸角、鼻翼基脚内倾角和鼻底宽度参数与主观评价结果没有明显相关性。

关键词: 单侧唇裂鼻畸形, 唇裂鼻畸形整复, 主观评价, 客观测量, 相关性研究

Abstract:

Objective To determine objective measurements affecting the subjective evaluation of the secondary reconstruction of unilateral cleft lip nasal deformity and further enhance unilateral cleft lip deformity results.Methods Eighty patients treated with secondary cleft rhinoplasty were enrolled. The study used the Asher-Mcdade subjective evaluation system to rate nasal appearance based on basilar view photographs to measure and record nose shape parameters. Correlation between subjective evaluation results and objective measurement parameters was investigated using multilevel model analysis.Result sMultilevel model analysis results showed that among five measurements on nasal parameters, statistically significant differences were observed only for nasal tip and columellar length between subjective evaluation and objective measurements.Conclusion Tip deviation and columellar length parameters could be used as prognostic indicators for grading subjective evaluation, whereas post-operative nasal alar convex angle, mesial inclination of ala, and nasal floor width parameters showed no significant correlation.

Key words: unilateral cleft nasal deformity, cleft rhinoplasty, subjective assessment, objective measurement, correlation study

中图分类号: 

  • R782

图 1

鼻部测量参数示意图左图由上至下测量参数：鼻尖对称参数（Prn-Ipl连线与Prn-Ipr连线的距离之比）;鼻小柱对称参数（裂侧与非裂侧Nt到Sn垂直距离之比）;鼻底对称参数（裂侧与非裂侧Am到Sn水平距离之比）;右图由左至右测量参数：鼻翼基脚内倾角（Prn-Sf连线与Ac-Sf连线构成的夹角）;鼻翼外凸角（Ac-Al连线与Ac水平线构成的内侧夹角）。"

表 1

多水平模型检验结果"

参数 估计 标准误 统计量值 P值
固定效应
截距 4.385 2.196 3.987 0.046
鼻尖对称参数 3.273 1.374 5.674 0.017
鼻翼外凸角 -0.021 0.013 2.609 0.106
鼻翼基脚内倾角 0.001 0.007 0.020 0.888
鼻底对称参数 1.472 0.808 3.319 0.068
鼻小柱对称参数 2.563 0.649 15.596 <0.001
随机效应
评价者（水平3方差） 0.248 0.082 9.147 0.002
评价时间（水平2方差） 0.809 0.092 77.325 <0.001
评价等级（水平1方差） 0.375 0.030 156.25 <0.001
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