From the Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Ann Plast Surg. 2021 Jul 1;87(1):98-104. doi: 10.1097/SAP.0000000000002582.
The interchondral joint between the sixth and seventh costal cartilages, called synchondrosis, assists in harvesting and fabricating the microtia framework. However, its looseness often complicates the microtia surgery. We aimed to classify the interchondral joints based on looseness and identify predictors for each subtype.
Electronic chart and intraoperative photographs were reviewed for consecutive microtia patients who underwent costal cartilage graft for ear reconstruction from June 2001 to February 2020. The sixth and seventh costal interchondral joint was classified in the ascending order of looseness-direct cartilaginous fusion (class I), synovial joint (class II), and loose tissue (class III)-with a minor modification from the cadaveric study of Dr. Briscoe in 1925. χ2 Tests compared the incidence of each subtype in terms of patient variables including age, sex, chest laterality, and radiologic chest deformity. Multivariate logistic regression was used for identifying independent predictors for each subtype.
Seven hundred thirty-three graft specimens were enrolled (mean age 12.1 years). Class I joint was seen in 137 (18.7%) grafts, class II in 544 (74.2%), and class III in 52 (7.1%). Female predilection was found for cartilaginous fusion (class I) (adjusted odds ratio, 1.691; P = 0.007). The incidence of loose joint (class III) was comparable, ranging from 4.6% to 12.5%, in terms of all the patient variables.
Loose interchondral joints were not uncommon in microtia surgery. Patient variables were less likely to predict this anatomical variation, necessitating some knowledge of managing the framework instability. Female patients were more likely to enable easy fabrication with directly fused costal cartilages.
第六和第七肋软骨之间的关节，称为骺关节，有助于采集和制作小耳畸形框架。然而，其松动常常使小耳畸形手术复杂化。我们旨在根据松动程度对骺关节进行分类，并确定每种亚型的预测因子。
回顾了 2001 年 6 月至 2020 年 2 月期间连续接受肋软骨移植进行耳再造的小耳畸形患者的电子病历和术中照片。根据 Briscoe 博士在 1925 年的尸体研究中的轻微修改，将第六和第七肋软骨间关节按松动程度从高到低分类为直接软骨融合（I 类）、滑膜关节（II 类）和疏松组织（III 类）。卡方检验比较了每种亚型在患者变量（包括年龄、性别、胸部侧位和放射学胸部畸形）方面的发生率。多变量逻辑回归用于确定每种亚型的独立预测因子。
共纳入 733 个移植物标本（平均年龄 12.1 岁）。137 个（18.7%）移植物为 I 类关节，544 个（74.2%）为 II 类关节，52 个（7.1%）为 III 类关节。软骨融合（I 类）中发现女性偏好（调整优势比，1.691；P=0.007）。根据所有患者变量，疏松关节（III 类）的发生率相似，范围为 4.6%至 12.5%。
在小耳畸形手术中，骺关节松动并不少见。患者变量不太可能预测这种解剖变异，因此需要一些管理框架不稳定的知识。女性患者更容易通过直接融合的肋软骨进行方便的制作。
