Gürlek Ali, Fariz Alpay, Aydoğan Hakan, Ersöz-Oztürk Ayşe, Evans Gregory R D
Department of Plastic Surgery, Medicana International Istanbul Hospital, Beylikdüzü-Istanbul, Turkey.
J Plast Reconstr Aesthet Surg. 2009 May;62(5):650-5. doi: 10.1016/j.bjps.2007.08.030. Epub 2008 Mar 24.
Although some studies about the effects of steroids on surgical trauma in closed or combined (closed and open together) rhinoplasty have been reported in the literature, still more information is needed in order to enlighten rhinoplasty surgeons. The purpose of this study is to evaluate the anti-inflammatory activity of steroids administered in high doses to prevent and decrease periorbital ecchymosis and oedema in patients who underwent open rhinoplasty with osteotomies by the same surgeon. This is the first study in open rhinoplasty alone.
The study was performed on 40 patients, under general anaesthesia. Patients were divided randomly into five groups (eight patients in each group); the groups comprised: a single 250 mg dose of methylprednisolone (Group I), a single 500 mg dose of methylprednisolone (Group II), four 250 mg doses of methylprednisolone (Group III), four 500 mg doses of methylprednisolone (Group IV) and placebo (Group V). Digital photographs were taken of each patient on the first, third and seventh postoperative days. Scorings of eyelid swelling and ecchymosis were evaluated separately using a graded scale from 0 to (+) 4 by three observers, independently. Additionally, blood samples were taken for the evaluations of C-reactive protein (CRP), white blood cell (WBC) and erythrocyte sedimentation rate (ESR) on the same days.
Clinically and statistically significant difference was observed in the decrease of both ecchymosis and oedema, between the placebo and high dose methylprednisolone groups, which is effective to prevent and to decrease both the ecchymosis and oedema in open rhinoplasty with osteotomies. CRP was the most sensitive acute phase reactant among CRP, ESR and WBC. No complication was observed due to steroid usage.
We can confidently say that high dose methylprednisolone is effective in preventing and reducing both the periorbital ecchymosis and oedema in open rhinoplasty with osteotomies and it can be used safely for this purpose.
尽管文献中已报道了一些关于类固醇对闭合性或联合性（闭合与开放同时进行）鼻整形手术创伤影响的研究，但仍需要更多信息来启发鼻整形外科医生。本研究的目的是评估高剂量类固醇的抗炎活性，以预防和减轻接受同一位外科医生进行截骨开放式鼻整形手术患者的眶周瘀斑和水肿。这是第一项仅针对开放式鼻整形手术的研究。
该研究在40例全身麻醉的患者中进行。患者被随机分为五组（每组8例）；分组如下：单次250mg剂量的甲泼尼龙（第一组）、单次500mg剂量的甲泼尼龙（第二组）、四次250mg剂量的甲泼尼龙（第三组）、四次500mg剂量的甲泼尼龙（第四组）和安慰剂（第五组）。在术后第1天、第3天和第7天对每位患者拍摄数码照片。由三名观察者独立使用从0到（+）4的分级量表分别评估眼睑肿胀和瘀斑的评分。此外，在同一天采集血样以评估C反应蛋白（CRP）、白细胞（WBC）和红细胞沉降率（ESR）。
在安慰剂组和高剂量甲泼尼龙组之间，瘀斑和水肿的减轻在临床和统计学上均有显著差异，这对于预防和减轻截骨开放式鼻整形手术中的瘀斑和水肿是有效的。在CRP、ESR和WBC中，CRP是最敏感的急性期反应物。未观察到因使用类固醇引起的并发症。
我们可以有信心地说，高剂量甲泼尼龙在预防和减轻截骨开放式鼻整形手术中的眶周瘀斑和水肿方面是有效的，并且可以安全地用于此目的。
