Liang Xuebing, Wang Keming, Malay Sunitha, Chung Kevin C, Ma Jiguang
17th Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System; Ann Arbor, MI, USA.
J Plast Reconstr Aesthet Surg. 2018 Aug;71(8):1164-1173. doi: 10.1016/j.bjps.2018.03.017. Epub 2018 Apr 11.
Both autologous costal cartilage (ACC) and alloplastic materials are widely used in rhinoplasty. However, there is controversy regarding which material can offer the ideal outcome and fewer complications.
The authors review current literature to evaluate complication and satisfaction rates with different materials used in rhinoplasty.
A comprehensive literature search of articles was conducted in Embase and PubMed published through April 14, 2017. We included only articles that used ACC, silicone, Medpor, Gore-Tex, or a combination of autologous and alloplastic materials in rhinoplasty. The primary outcomes analyzed were complications and postoperative satisfaction. After data extraction, meta-analysis using the random effect model was performed to summarize outcome parameters among different implant types.
Fifty-three articles met inclusion criteria and were included in the meta-analysis. The overall complication rate of ACC was 14%, which was higher than that of other implants. However, ACC was more commonly used in revision rhinoplasty. Medpor was associated with low overall complication rates (6%) and good aesthetic and functional outcomes.
Our analysis of available evidence suggests that ACC is preferred in revision rhinoplasty, which may explain its association with higher complication rates. In primary rhinoplasty, Medpor offered versatility in addition to low complication rates and good aesthetic and function outcomes. But its potential dramatic damage to the nasal tissue made secondary surgery extremely difficult. Our findings were limited by lack of high-quality evidence. Future studies with rigorous study design for head-to-head comparisons and longer follow-up are needed to establish clear guidelines for choosing the appropriate rhinoplasty graft material.
自体肋软骨（ACC）和异体材料都广泛应用于鼻整形手术。然而，关于哪种材料能带来理想效果且并发症更少存在争议。
作者回顾当前文献，以评估鼻整形手术中使用不同材料的并发症发生率和满意度。
在Embase和PubMed上对截至2017年4月14日发表的文章进行全面文献检索。我们仅纳入在鼻整形手术中使用ACC、硅胶、Medpor、戈尔特斯（Gore-Tex）或自体与异体材料组合的文章。分析的主要结果是并发症和术后满意度。数据提取后，采用随机效应模型进行荟萃分析，以总结不同植入物类型的结果参数。
53篇文章符合纳入标准并被纳入荟萃分析。ACC的总体并发症发生率为14%，高于其他植入物。然而，ACC更常用于鼻整形修复手术。Medpor的总体并发症发生率较低（6%），且美学和功能效果良好。
我们对现有证据的分析表明，ACC在鼻整形修复手术中更受青睐，这可能解释了其与较高并发症发生率的关联。在初次鼻整形手术中，Medpor除了并发症发生率低、美学和功能效果良好外，还具有多样性。但其对鼻组织可能造成的严重损伤使得二次手术极为困难。我们的研究结果受到缺乏高质量证据的限制。未来需要进行设计严谨的头对头比较研究并进行更长时间的随访，以建立选择合适鼻整形移植材料的明确指南。
