From private practice; Sutter Hospital; Plastic Surgery Center; the University of California, Davis Medical Center; the Division of Plastic Surgery, University of California Medical Center.
Plast Reconstr Surg. 2019 Jan;143(1):49e-61e. doi: 10.1097/PRS.0000000000005166.
The aim of this study was to evaluate freeze-dried cortical allograft bone for nasal dorsal augmentation. The 42-month report on 18 patients was published in 2009 in Plastic and Reconstructive Surgery with 89 percent success at level II evidence, and this article is the 10-year comprehensive review of 62 patients.
All grafts met standards recommended by the American Association of Tissue Banks, the U.S. Food and Drug Administration, and the Centers for Disease Control and Prevention. Objective evaluation of the persistence of graft volume was obtained by cephalometric radiography, cone beam volumetric computed tomography, and computed tomography at up to 10 years. Vascularization and incorporation of new bone elements within the grafts were demonstrated by fluorine-18 sodium fluoride positron emission tomography at up to 10 years. Subjective estimation of graft volume persisting up to 10 years was obtained by patient response to a query conducted by an independent surveyor.
The authors report objective proof of persistence of volume alone or combined with proof of neovascularization in 16 of 19 allografts. The authors report the patient's subjective opinion of volume persistence in 37 of 43 grafts. The dorsal augmentation was assessed overall to be successful in 85 percent of 62 patients evaluated between 1 and 10 years, with a mean of 4.7 years.
Freeze-dried allograft bone is a safe and equal alternative for dorsal augmentation without donor-site morbidity. Further studies are needed to (1) confirm these findings for young patients needing long-term reconstruction, and (2) partially demineralize allograft bone to allow carving with a scalpel.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
本研究旨在评估冻干皮质同种异体骨在鼻背增高中的应用。2009 年，《整形与重建外科》杂志发表了 18 例患者的 42 个月随访结果，其证据水平为 II 级，成功率为 89%。本文是对 62 例患者的 10 年综合回顾。
所有移植物均符合美国组织库协会、美国食品药品监督管理局和疾病控制与预防中心推荐的标准。通过头颅侧位 X 线片、锥形束容积 CT 和 CT 对移植物体积的持续情况进行客观评估，最长可达 10 年。通过氟-18 氟化钠正电子发射断层扫描对移植物内新骨元素的血管化和吸收情况进行长达 10 年的评估。通过独立调查员进行的查询，获取患者对移植物体积持续长达 10 年的主观估计。
作者报告了 19 个同种异体移植物中有 16 个在体积持续存在方面有客观证据，或在体积持续存在的基础上有新血管生成的证据。作者报告了 37 个移植物中有 37 个患者对体积持续存在的主观意见。在 62 例接受 1 至 10 年评估的患者中，85%的患者鼻背增高术整体成功，平均随访时间为 4.7 年。
冻干同种异体骨是一种安全且等效的选择，可用于鼻背增高，无供区并发症。需要进一步研究：(1) 为需要长期重建的年轻患者证实这些发现；(2) 部分脱矿化同种异体骨，使其可使用手术刀雕刻。
临床问题/证据水平：治疗，IV 级。
