Division of Plastic and Reconstructive Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, United States.
Division of Plastic and Reconstructive Surgery, UC Davis School of Medicine, Sacramento, CA, United States.
J Plast Reconstr Aesthet Surg. 2024 Sep;96:231-241. doi: 10.1016/j.bjps.2024.06.019. Epub 2024 Jul 18.
Crushed cartilage grafts improve augmentation and contour irregularities in rhinoplasty; however, they are associated with complications including resorption, asymmetries, palpability, and need for revision surgery.
A systematic review and meta-analysis following the preferred reporting items for systematic reviews and meta-analyses guidelines was performed on all recorded history up to November 2022 using the search query ("crush" or "crushed") AND cartilage AND rhinoplasty for PubMed, World of Science, Embase, and Cochrane online registries. Data were collected on study information, patient demographics, surgical details, and outcomes. Graft resorption and revision surgery were pooled in a random-effects model, and a subgroup analysis was performed for coverage/non-coverage of the cartilage and degree of crushing.
The initial search yielded 163 results, with 11 studies included in the final full-text review. A total of 1132 patients were analyzed, with 456 (40.3%) women, mean age of 48.0 years, and an average follow-up period of 24.9 months. Cartilage resorption rates were statistically higher in graft preparation using severely crushed cartilage (3.4%) compared to non-severely crushed cartilage (0.9%, p = 0.049). There was no significant difference in resorption rate for patients with covered cartilage graft (1.3%) compared to those with non-covered grafts (1.8%, p = 0.7). There were significantly more revision surgeries for severely crushed (17.9%) compared to non-severely crushed (3.5%, p = 0.003) cartilage grafts.
Severely crushed cartilage grafting provides smooth contour and less palpability compared to other degrees of crushing but demonstrates significantly higher rate of resorption.
压碎的软骨移植物可改善鼻整形术中的填充和轮廓不规则；然而，它们与并发症相关，包括吸收、不对称、可触知性和需要进行修复手术。
对截至 2022 年 11 月的所有记录历史进行了系统评价和荟萃分析，使用的搜索查询为（“压碎”或“crushed”）和软骨和鼻整形术，检索数据库包括 PubMed、World of Science、Embase 和 Cochrane 在线注册库。收集了研究信息、患者人口统计学、手术细节和结果。在随机效应模型中汇总了移植物吸收和修复手术的数据，并对软骨的覆盖/未覆盖和压碎程度进行了亚组分析。
最初的搜索产生了 163 个结果，最终有 11 项研究纳入了全文审查。共分析了 1132 例患者，其中 456 例（40.3%）为女性，平均年龄为 48.0 岁，平均随访时间为 24.9 个月。与非重度压碎软骨相比，使用重度压碎软骨制备的软骨移植物的吸收率统计上更高（3.4%比 0.9%，p=0.049）。覆盖软骨移植物（1.3%）与未覆盖移植物（1.8%）相比，吸收率没有显著差异（p=0.7）。与非重度压碎软骨相比，重度压碎软骨（17.9%）的修复手术明显更多（3.5%，p=0.003）。
与其他压碎程度相比，重度压碎软骨移植物提供更平滑的轮廓和更低的可触知性，但吸收率明显更高。
