OBJECTIVE: In 1993, Kridel and Konior published a preliminary report (in the Archives of Otolaryngology-Head and Neck Surgery) on the use of irradiated homologous costal cartilage (IHCC) or homograft cartilage in the nose. This is a follow-up study to share our experience in answering fundamental questions: (1) What are the major long-term complications of IHCC, and are they any greater than with the use of the patient's own cartilage? (2) Is IHCC a reliable and safe implant? (3) Does IHCC resorb over time? (4) What measures are implemented in our practice to minimize the sequelae?
摘要：1993年，Kridel和Konior发表了关于在鼻子中使用辐射同种异体软骨（IHCC）或同种异体软骨的初步报告（发表于《中国耳鼻咽喉头颈外科》月刊）。这是一项随访研究，以分享我们在回答基本问题时的经验：（1）IHCC的主要长期并发症是什么？它们比使用患者自己的软骨时更严重吗？ （2）IHCC是否是可靠和安全的植入物？ （3）IHCC随着时间的推移吸收吗？ （4）在实践中，我们采取了哪些措施来尽量减少后遗症？
DESIGN: We performed a retrospective review of patient medical charts in a university-affiliated private practice setting. A total of 357 patients underwent primary or revision rhinoplasty using IHCC grafts with postoperative follow-up duration ranging from 4 days to 24 years (mean [SD], 13.45 [2.83] years). A total of 1025 IHCC grafts and 373 other grafts (including 218 autogenous cartilage [AC] grafts) were used. A total of 201 grafts were dorsal onlay grafts, and 74 of them have been further followed up since the previous report. The grafts were evaluated for warping, infection, infective resorption, noninfective resorption, mobility, and extrusion. Patient satisfaction evaluation was performed in 42 patients.
设计：我们在一家大学附属私立医院对患者医疗图表进行了回顾性回顾。 共有357例患者使用IHCC移植术进行原发性或修复性鼻整形术，术后随访时间为4天至24年（平均值【SD】，13.45 【2.83】年）。共使用1025件IHCC移植物和373件其他移植物（包括218件自体软骨【AC】移植物）。 共有201件移植物为背侧移植物，自上次报告后对其中74件做了进一步随访。从翘曲、感染、感染吸收、非感染吸收、移动性和挤出几方面对移植物进行了评估。 对42例患者进行了满意度评估。
RESULTS: The total complication rate related to IHCC grafts was 3.25%, which included 10 warped grafts of 941 palpable or superficial IHCC grafts (1.06%), 9 infections of 1025 IHCC grafts (0.87%), 5 cases of infective resorption of 1025 IHCC grafts (0.48%), 5 noninfective resorptions of 943 palpable IHCC grafts (0.53%), and 3 cases of graft mobility of 941 palpable grafts (0.31%). Nine cases of local infection were treated and could have arisen from any of the 1025 IHCC grafts as well as from the 373 other grafts. Among the 9 cases of infection, in 2 patients IHCC grafts were used alone, and in 7 patients IHCC grafts were used in combination with other types of graft materials; therefore, the actual infection rate related to the pure use of IHCC was 2 of 1025 or 0.2%.
结果：与IHCC移植相关的并发症发生率为3.25％，其中包括941件可感知或表面IHCC移植物（1.06％）中，有10件发生翘曲；1025件IHCC移植物中，有9件发生感染（0.87％）；1025件IHCC移植物中，有5例发生感染吸收 （0.48％）；943件可感知IHCC移植物中，有5件发生非感染性吸收（0.53％）；941件可感知移植物中，有3件发生移动（0.31％）。
对9件发生局部感染的病例进行了诊治，这9件可能来自任何1025件IHCC移植物以及373件其他移植物。 在9件感染病例中，其中2例患者的IHCC移植物是单独使用的，余下7例患者的IHCC移植物是与其他类型的移植材料结合使用的; 因此，与IHCC纯粹使用有关的实际感染率为2/1025，即0.2％。
Of the 218 AC grafts used at the same operative intervention along with IHCC grafts, 3 grafts (1.37%) underwent minimal resorption. The overall comparative resorption rates were 1.01% (IHCC) vs 1.37% (AC). The complication rate in conjunction with the use of 162 IHCC s in 53 cases of septal perforation repair was 2.46% (4 cases), including only 1 case of infection, 1 case of mobility of the graft, 1 case of warping, and 1 case of infective resorption (0.61% for all). Of the 25 AC grafts used in septal perforation cases, there were 2 cases of noninfective resorption (8%). The overall comparative complication rates in septal perforation cases were 2.46% for IHCC vs 8% for AC, which indicated a 3.25-times higher complication with the AC than with IHCC. No allergic reaction or systemic disease was reported by patients as a result of use of the IHCC. Irradiated homograft cartilage also proved to be a reliable graft in 2 patients with progressive autoimmune diseases over 2.08 years and 10 years of follow-up. The average rates of patient satisfaction increased during a mean follow-up of 7.87 years, from 91.31% to 94.18%, in 4 categories, including nasal appearance, nasal breathing, nasal symptoms, and quality of life.
在与IHCC移植物相同的手术干预中使用的218件AC移植物中，有3例（1.37％）进行了最小吸收。 总体比较吸收率分别为1.01％（IHCC）和1.37％（AC）。结合使用162件IHCC移植物的53例鼻中隔穿孔修复的并发症发生率为2.46％（4例），其中仅1例感染，1例移植物移植，1例翘曲，1例 感染吸收（0.61％）。在鼻中隔穿孔病例中使用的25件AC移植物中，有2件发生无效吸收（8％）。在鼻中隔穿孔病例中使用IHCC和AC的整体比较并发症发生率分别为2.46％和8％，这表明，与使用HICC的病例相比，使用AC的病例的并发症高出3.25倍。使用IHCC的患者中没有有关过敏反应或全身性疾病的报告。在2.08年和10年的随访中，2例患有进行性自身免疫性疾病患者的辐射同种异体软骨也被证实为可靠的移植物。平均随访时间为7.87年，平均患者满意率从91.31％上升到94.18％，随访项目包括鼻外观、鼻呼吸、鼻部症状和生活质量等4类。
CONCLUSIONS: Based on careful and extensive review of the data, we have concluded that IHCC is well tolerated as a grafting material in rhinoplasty and yields superb functional, structural, and cosmetic results in the most complex and challenging operative cases necessitated by previous unsuccessful nasal surgery, septal perforations, and even in autoimmune diseases that led to nasal deformity. Not only did very few complications occur following the use of 1025 IHCC grafts in 357 patients after 386 rhinoplasties over 24 years (rate, 3.25%), but the rate of complications was no greater than rhinoplasty complication rates when AC grafts are used. The results indicate safety and reliability and justify the convenient use of IHCC grafts for primary and revision rhinoplasty without creating donor site morbidity. Irradiated homograft cartilage grafts are quite stable in the nose and maintain structural contour and support in most cases. Irradiated homograft cartilage grafts should be considered as an alternative or even a primary grafting material when the patient does not have adequate quantities of septal or auricular cartilage remaining to provide the correction or when the shape or quality of such an AC does not adequately provide the structure required. Autogenous rib cartilage is also an alternative material but also increases operative and anesthesia time and adds potential morbidity. The use of IHCC is both cost- and time-effective.
结论：根据对数据的仔细和广泛的回顾，我们得出结论，IHCC作为鼻成形术中的移植材料具有良好的耐受性，并且在以前不成功的鼻腔手术、间隔穿孔、甚至导致鼻畸形的自身免疫性疾病所需的最复杂和最具有挑战性的手术病例中产生了极好的功能、结构和美观效果 。不仅在24年后386例鼻窦炎患者中，使用1025件IHCC移植物的357例患者术后并发症发生率极低（发生率为3.25％），而且使用AC移植物术后并发症发生率亦不高于鼻整形术并发症发生率，从而表明其安全性和可靠性，并且证明IHCC移植物在原发性和修复性鼻整形术中的便利使用是合理的，不会造成供体部位发病。辐照同种异体软骨移植物在鼻子中相当稳定，并且在大多数情况下可保持结构轮廓和支撑。当患者没有足够数量的鼻中隔软骨或耳软骨残留以提供矫正时，或当这种AC的形状或质量不能充分地提供所需结构时，就会选用辐射同种异体软骨移植物作为替代移植材料甚或将其作为主要移植材料来使用。自体肋骨软骨也可作为替代材料，但同时会增加手术和麻醉时间以及潜在的发病率。使用IHCC既具有成本效益，又具有时效性。
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