Lindsey W H, Ogle R C, Morgan R F, Cantrell R W, Sweeney T M
Department of Otolaryngology-Head and Neck Surgery, University of Virginia Medical Center, Charlottesville, USA.
Arch Otolaryngol Head Neck Surg. 1996 Jan;122(1):37-40. doi: 10.1001/archotol.1996.01890130031004.
Congenital malformations, granulomatous diseases, and trauma can all cause destruction of the nasal structural framework, resulting in functional nasal obstruction and altered facial cosmesis. Current methods of nasal reconstruction include cartilaginous and bony grafts, Silastic implants, and homograft only materials. However, these techniques have significant functional and cosmetic drawbacks and are not risk free. Native, isotonic, neutral-pH, space-filling type I collagen gels have been shown to mediate total repair of critical-size collagen grafts provide a framework for rapid intramembranous ossification and osteoconduction of bone from the perimeter of a defect, resulting in total bony coverage.
To evaluate a novel approach to nasal reconstruction using a major defect of the bony nasal dorsum with a type I collagen gel matrix.
Sixteen retired male breeder Sprague-Dawley rats were divided into control and experimental groups. The nasal bones were exposed through a dorsal incision and completely removed with a bone-cutting drill to the level of the mucosal membranes of the nasal vestibule. Defects in the experimental animals were then implanted with 200 micrograms of type I collagen gel, with control animals receiving no inlay. After 6 weeks, the animals were examined with three-dimensional computed tomography before necropsy, at which time the defects were photographed, measured by planimetry, and sectioned for histologic analysis.
Experimental defects were observed to manifest 100% surface area healing with a thin layer of bone using a type I collagen gel osteoconductive implant for nasal reconstruction. Conversely, control animals showed only a 5.7% (+/- 3.7% SD) healing by area. Histologic sections of the collagen gel implant revealed restoration of the anatomy with a thin plate of immature bone spanning the defect in continuity with the cartilage of the nasal septum and with apparent preservation of maxillonasalis suture lines.
Native, isotonic, neutral-pH, space-filling collagen gels positively influenced the repair of large nasal defects, which showed minimal bone closure in untreated animals. Their use in this role merits further investigation.
先天性畸形、肉芽肿性疾病和外伤均可导致鼻结构框架破坏，引起功能性鼻阻塞并改变面部美观。目前的鼻重建方法包括软骨和骨移植、硅橡胶植入物以及仅使用同种异体移植材料。然而，这些技术存在明显的功能和美容缺陷，且并非毫无风险。天然、等渗、中性pH值、填充空间的I型胶原凝胶已被证明可介导临界尺寸胶原移植物的完全修复，为快速膜内成骨以及骨从缺损周边的骨传导提供框架，从而实现完全的骨覆盖。
评估一种使用I型胶原凝胶基质修复鼻背骨大缺损的新型鼻重建方法。
将16只退休的雄性繁殖斯普拉格-道利大鼠分为对照组和实验组。通过背部切口暴露鼻骨，并用骨钻将其完全切除至鼻前庭黏膜水平。然后在实验组动物的缺损处植入200微克I型胶原凝胶，对照组动物不进行植入。6周后，在尸检前用三维计算机断层扫描对动物进行检查，此时对缺损进行拍照、用面积测量法测量，并切片进行组织学分析。
观察到使用I型胶原凝胶骨传导植入物进行鼻重建时，实验组缺损的表面积愈合率达100%，有一层薄骨。相反，对照组动物的面积愈合率仅为5.7%（±3.7%标准差）。胶原凝胶植入物的组织学切片显示解剖结构得以恢复，有一块薄的未成熟骨板跨越缺损，与鼻中隔软骨连续，上颌鼻缝明显保留。
天然、等渗、中性pH值、填充空间的胶原凝胶对大的鼻缺损修复有积极影响，在未治疗的动物中这些缺损的骨闭合极少。其在该用途上值得进一步研究。
