Xie Jiang,Zhao Sijun,Peng Xiangyue,et al.Application of Modified Nagata Method Phase Ⅱ Ear Standing Technique in Non Dilated Total Ear Reconstruction in Children[J].Journal of Clinical Pediatric Surgery,2026,(07):672-675.[doi:10.3760/cma.j.cn101785-20260318-00121]
改良Nagata法二期立耳技术在儿童非扩张全耳再造中的应用
- Title:
- Application of Modified Nagata Method Phase Ⅱ Ear Standing Technique in Non Dilated Total Ear Reconstruction in Children
- Keywords:
- Child; Microtia; Ear Reconstruction
- 摘要:
- 目的 探讨改良Nagata法二期立耳技术流程标准化在儿童小耳畸形非扩张全耳再造中的应用价值,总结手术要点并分析临床疗效。方法 回顾性分析2018年1月至2020年11月湖南省儿童医院收治的55例单侧先天性小耳畸形患儿资料。其中男45例、女10例,年龄(9.50±2.15)岁,均为单侧小耳畸形。评估测量55例患儿再造耳廓的精细结构(耳轮、对耳轮、耳甲腔等亚结构)、耳颅角大小、耳廓高度。结果 55例均顺利完成手术。再造耳精细结构评价为优的42例(76.4%),为良的13例(23.6%),无一般或较差病例。再造耳耳颅角为(38.11±0.97)°,与健侧耳(38.53±2.10)°相比,差异无统计学意义(P>0.05);再造耳高度为(19.16±1.60)mm,与健侧(20.13±1.65)mm相比,差异有统计学意义(P<0.05),但临床对称性良好,再造耳立体感突出。术后仅2例出现轻度皮瓣血运障碍,经对症处理后愈合,无支架外露、感染、软骨吸收等严重并发症。结论 将改良Nagata法二期立耳技术进行流程标准化,并应用于儿童非扩张全耳再造,可有效保障操作的规范性与可重复性,降低并发症风险,获得稳定、对称的颅耳角形态,临床应用安全可靠。
- Abstract:
- Objective To explore the value of standardized application of modified two-stage Nagata method for ear elevation during non-expansion total ear reconstruction in children with microtia,summarize the key points of surgery and analyze the clinical efficacy. Methods This study retrospectively analyzed the data of 55 children with unilateral congenital microtia admitted to Hunan Children’s Hospital from January 2018 to November 2020. There were 45 boys and 10 girls with an age range of (6-16)(9.50±2.15) year.The fine structures of reconstructed auricles (helix,antihelix,concha & other substructures),size of auriculocephalic angle and height of auricle were measured.Results All of them successfully completed the surgery.Among them,42 cases (76.4%) were rated as excellent in terms of reconstructed ear’s fine structure,13 cases (23.6%) were rated as good and none as fair/poor.The average reconstructed auriculocephalic angle was (38.11±0.97)° and (38.53±2.10)° at healthy side.It showed no statistically significant difference (P>0.05).The average height of reconstructed ear was (19.16±1.60) mm and (20.13±1.65) mm at healthy side,showing a statistically significant difference (P<0.05).However,clinical symmetry was excellent with a prominent three-dimensional appearance of reconstructed ear.Postoperatively,only 2 cases exhibited mild flap vascular complications.Both healed after symptomatic treatment.No severe complications such as cartilage framework exposure,infection or cartilage resorption occurred. Conclusion Standardizing the modified Nagata method’s second-stage ear elevation technique and applying it to non-expansion total ear reconstruction in children can effectively ensure the standardization and reproducibility of operation,lower the risk of complications and achieve a stable,symmetrical auriculocephalic angle morphology,making its clinical application safe and reliable.
参考文献/References:
[1] 中华耳鼻咽喉头颈外科杂志编辑委员会.先天性外中耳畸形患者骨传导助听器应用专家共识[J].中华耳鼻咽喉头颈外科杂志,2024,35(3):984-992.DOI:10.1097/SCS.0000000000009908. Editorial Board of Chinese Journal of Otorhinolaryngology Head and Neck Surgery.Expert Consensus on the Application of Bone-conducted Hearing Device in Patients with Congenital Middle and External Ear Mlformations[J].Chin J Otorhinolaryngol Head Neck Surg,2024,59(3):197-203.DOI:10.3760/cma.j.cn115330-20240128-00049.
[2] Wei Y,Li L,Xie C,et al.Current status of auricular reconstruction strategy development[J].J Craniofac Surg,2024,35(3):984-992.DOI:10.1097/SCS.0000000000009908.
[3] Li YY,Zhang RH,Zhang Q,et al.An alternative posterosuperior auricular fascia flap for ear elevation during microtia reconstruction[J].Aesthetic Plast Surg,2017,41(1):47-55.DOI:10.1007/s00266-016-0743-5.
[4] Gao SY,Nie TQ,Lin Y,et al.3D printing tissue-engineered scaffolds for auricular reconstruction[J].Mater Today Bio,2024,27:101141.DOI:10.1016/j.mtbio.2024.101141.
[5] 何乐人,蒋海越.在摸索中趋同的小耳畸形耳再造术[J].中国美容整形外科杂志,2021,32(4):193-196.DOI:10.3969/j.issn.1673-7040.2021.04.001. He LR,Jiang HY.Ear reconstruction:from divergence to convergence in pursing excellence[J].Chin J Aesthet Plast Surg,2021,32(4):193-196.DOI:10.3969/j.issn.1673-7040.2021.04.001.
[6] Firmin F,Marchac A.A novel algorithm for autologous ear reconstruction[J].Semin Plast Surg,2011,25(4):257-264.DOI:10.1055/s-0031-1288917.
[7] Xu ZC,Li YY,Li DT,et al.Strategies for ear elevation and the treatment of relevant complications in autologous cartilage microtia reconstruction[J].Sci Rep,2022,12(1):13536.DOI:10.1038/s41598-022-17007-3.
[8] 石润杰.先天性小耳畸形功能与形态的一期重建[D].上海:上海交通大学,2013. Shi RJ.Auricular reconstruction and hearing rehabilitation of congenital microtia at one-stage[D].Shanghai:Shanghai Jiao Tong University,2013.
[9] Chai ZX,Fan YC,Wang L,et al.Progress in auricular reconstruction techniques:a review[J].Ann Plast Surg,2026,96(1):112-116.DOI:10.1097/SAP.0000000000004568.
[10] Mazeed AS,O’hara J,Bulstrode NW.Modification of the cartilaginous framework for autologous ear reconstruction:construction of a stable complete ring framework with grander highs and lows[J].J Plast Reconstr Aesthet Surg,2021,74(8):1832-1839.DOI:10.1016/j.bjps.2020.11.042.
[11] Yang MR,Pan B,Yu XB."Mortise and tenon joint" technique to improve the stability of three-dimensional costal cartilage framework in fully expansion ear reconstruction[J].J Craniofac Surg,2025,36(1):286-289.DOI:10.1097/SCS.0000000000010705.
[12] Li YY,Cui CX,Zhang RH,et al.Anatomical and histological evaluation of the retroauricular fascia flap for staged auricular reconstruction[J].Aesthetic Plast Surg,2018,42(3):625-632.DOI:10.1007/s00266-018-1098-x.
[13] Ibrahiem SMS.Concha-type microtia:new surgical incision[J].Aesthet Surg J,2023,43(11):NP815-NP822.DOI:10.1093/asj/sjad191.
[14] Wu X,Fu YY,Ma J,et al.Blocking calcium-MYC regulatory axis inhibits early dedifferentiation of chondrocytes and contributes to cartilage regeneration[J].Stem Cell Res Ther,2025,16(1):372.DOI:10.1186/s13287-025-04483-3.
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备注/Memo
收稿日期:2026-3-18。
基金项目:湖南省出生缺陷协同防治科技重大专项(2019SK1015);湖南省科学技术协会"基层科普行动计划"(2026KPB—KT050)
通讯作者:黄敏,Email:3150612129@qq.com