مقايسه ميزان جذب گرافت غضروف گوش به فرم خرد شدة داراي پريكندريوم و بدون آن در خرگوش آزمايشگاهي

Comparison of the Absorption Rate of Diced Ear Cartilage Graft with and without Perichordrium in Rabbit

ﺯﻣﻴﻨﻪ ﻭ ﻫﺪﻑ: ﮔﺮﺍﻓﺖ ﻏﻀﺮﻭﻑ ﺑﻪ ﻃﻮﺭ ﺷﺎﻳﻊ ﺩﺭ ﺟﺮﺍﺣﻲ ﺗﺮﻣﻴﻤﻲ ﻭ ﭘﻼﺳﺘﻴﻚ ﺑﻪ ﻋﻨﻮﺍﻥ ﺍﺻﻼﺡ ﺩﻓﻮﺭﻣﻴﺘﻲ ﻫﺎﻱ ﺑﺪﻥ ﺑﻪ ﺧﺼﻮﺹ ﺻﻮﺭﺕ ﺑﻜﺎﺭ ﻣﻲ ﺭﻭﺩ. ﺟﺬﺏ ﻏﻀﺮﻭﻑ ﭘﻴﻮﻧﺪ ﺷﺪﻩ ﻳﻜﻲ ﺍﺯ ﻣﺸﻜﻼﺕ ﺍﻳﻦ ﺭﻭﺵ ﺍﺳﺖ. ﺧﺮﺩ ﻛﺮﺩﻥ ﻭ ﺣﻔﻆ ﭘﺮﻳﮑﻨﺪﺭﻳﻮﻡ ﻣﻤﮑﻦ ﺍﺳﺖ ﺑﺎﻋﺚ ﻧﺘﺎﻳﺞ ﺑﻬﺘﺮ ﺑﺎﺯﺳﺎﺯﻱ ﺷﻮﺩ. ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ: ﺩﺭ ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺍﺯ 28 ﻧﻤﻮﻧﻪ ﻏﻀﺮﻭﻓﻲ ﮔﻮﺵ ﺧﺮﮔﻮﺵ ﻧﺮ ﺳﻔﻴﺪ ﻧﮋﺍﺩ ﻧﻴﻮﺯﻟﻨﺪﻱ، ﺑﺎ ﻭﺯﻥ ﺗﻘﺮﻳﺒﻲ 1500-2000 ﮔﺮﻡ ﻭ ﺳﻦ 12 -14 ﻫﻔﺘﻪ ﺍﺳﺘﻔﺎﺩﻩ ﺷﺪﻩ ﺍﺳﺖ. ﭘﺲ ﺍﺯ ﺍﻳﺠﺎﺩ ﺑﻴﻬﻮﺷﻲ ﻋﻤﻮﻣﻲ ﺑﻪ ﺭﻭﺵ ﺍﺳﺘﺎﻧﺪﺍﺭﺩ ﺩﺭ ﺧﺮﮔﻮﺵ ﻫﺎ، ﺍﺯ ﻳﮑﻲ ﺍﺯ ﮔﻮﺵ ﻫﺎ ﺩﻭ ﻗﻄﻌﻪ ﻏﻀﺮﻭﻑ ﺗﻬﻴﻪ ﺷﺪ. ﺩﺭ ﺩﻭﻃﺮﻑ ﺧﻂ ﻭﺳﻂ ﻭ ﺩﺭ ﻧﺎﺣﻴﻪ ﭘﺸﺖ ﺣﻴﻮﺍﻥ ﻭ ﻋﻘﺐ ﮐﺘﻒ ﻫﺎ ﺩﻭ ﺑﺮﺵ ﺩﺭ ﭘﻮﺳﺖ ﺍﻳﺠﺎﺩ ﺷﺪ. ﺳﭙﺲ ﻳﻚ ﻧﻤﻮﻧﻪ ﺑﻪ ﻫﻤﺎﻥ ﺷﻜﻞ ﺧﺮﺩ ﺷﺪﻩ ﻭ ﺩﺭ ﻳﻚ ﺣﻔﺮﻩ ﺯﻳﺮ ﺟﻠﺪﻱ ﺩﺭ ﻫﻤﺎﻥ ﻃﺮﻑ ﻛﺎﺷﺘﻪ ﺷﺪ. ﻧﻤﻮﻧﻪ ﺩﻭﻡ ﻏﻀﺮﻭﻑ ﮔﻮﺵ ﺧﺮﮔﻮﺵ ﻗﻄﻌﻪ ﻗﻄﻌﻪ ﺷﺪﻩ ﻭﻟﻲ ﭘﺮﻳﮑﻨﺪﺭﻳﻮﻡ ﺩﺭ ﻳﮏ ﺳﻤﺖ ﻏﻀﺮﻭﻑ ﺣﻔﻆ ﮔﺮﺩﻳﺪ. ﺍﻳﻦ ﻧﻤﻮﻧﻪ ﻧﻴﺰ ﺩﺭ ﻳﻚ ﺣﻔﺮﻩ ﺯﻳﺮ ﺟﻠﺪﻱ ﻣﺸﺎﺑﻪ ﺩﺭ ﻃﺮﻑ ﺩﻳﮕﺮ ﺧﺮﮔﻮﺵ ﻗﺮﺍﺭ ﮔﺮﻓﺖ. ﭘﺲ ﺍﺯ 3 ﻣﺎﻩ ﻭ ﭘﺲ ﺍﺯ ﻣﻌﺪﻭﻡ ﮐﺮﺩﻥ ﺣﻴﻮﺍﻧﺎﺕ ﺑﻪ ﻃﻮﺭ ﺍﺳﺘﺎﻧﺪﺍﺭﺩ، ﺩﻭ ﻧﻤﻮﻧﻪ ﺍﺯ ﺣﻔﺮﻩ ﻫﺎﻱ ﻣﺰﺑﻮﺭ ﺧﺎﺭﺝ ﻭ ﻣﺠﺪﺩﺍﹰ ﺍﻧﺪﺍﺯﻩ ﮔﻴﺮﻱ ﺷﺪ. ﺩﺭ ﭘﺎﻳﺎﻥ ﻧﺘﺎﻳﺞ ﺑﺮ ﺍﺳﺎﺱ ﺗﻮﺯﻳﻦ ﺍﺳﺘﺎﻧﺪﺍﺭﺩ ﻏﻀﺮﻭﻑ ﻫﺎ ﻣﻮﺭﺩ ﻣﻘﺎﻳﺴﻪ ﻗﺮﺍﺭ ﮔﺮﻓﺖ. ﻳﺎﻓﺘﻪ ﻫﺎ: ﻭﺯﻥ ﻫﺎ ﺩﺭ ﺩﻭ ﮔـﺮﻭﻩ ﻣﻮﺭﺩ ﻣﻄﺎﻟﻌﻪ )ﺍﻧﺠﺎﻡ ﭘﻴﻮﻧﺪ ﻏﻀﺮﻭﻑ ﺑﺎ ﭘﺮﻳﮑﻨـﺪﺭﻳﻮﻡ ﻭ ﭘﻴﻮﻧﺪ ﺑﺪﻭﻥ ﭘﺮﻳﮑﻨﺪﺭﻳﻮﻡ( ﺍﺑﺘﺪﺍﻱ ﺍﻣﺮ ﻣﻮﺭﺩ ﺗﻮﺯﻳﻦ ﻗﺮﺍﺭ ﮔـﺮﻓﺘﻨﺪ ﮐﻪ ﺗﻔﺎﻭﺕ ﻣﻌﻨﺎﺩﺍﺭ ﺁﻣﺎﺭﻱ ﻧﺪﺍﺷﺘﻪ ﺍﻧﺪ )0.21=P-value(. ﺳﭙﺲ ﻧﺘﺎﻳﺞ ﺩﺭ ﺳﻪ ﻣﺎﻩ ﭘﺲ ﺍﺯ ﺗﺮﻣﻴـﻢ ﻣﻮﺭﺩ ﻣﻘﺎﻳﺴﻪ ﻗﺮﺍﺭ ﮔﺮﻓﺖ ﮐﻪ ﻭﺯﻥ ﻫﺎ ﺩﺭ ﮔﺮﻭﻩ ﭘﻴﻮﻧﺪ ﻏﻀﺮﻭﻑ ﺑﺎ ﭘﺮﻳﮑﻨـﺪﺭﻳﻮﻡ ﭘﺲ ﺍﺯ ﺳﻪ ﻣﺎﻩ ﺍﻓﺰﺍﻳﺶ ﻳﺎﻓﺘﻪ ﻭ ﻧﺴﺒﺖ ﺑﻪ ﮔﺮﻭﻩ ﭘﻴﻮﻧﺪ ﻏﻀﺮﻭﻑ ﺑﺪﻭﻥ ﭘﺮﻳﮑﻨـﺪﺭﻳﻮﻡ ﺗﻔﺎﻭﺕ ﻣﻌﻨﺎﺩﺍﺭ ﺁﻣﺎﺭﻱ ﺩﺭ ﺳﻪ ﻣﺎﻩ ﭘﺲ ﺍﺯ ﺗﺮﻣﻴـﻢ ﻭﺟﻮﺩ ﺩﺍﺷﺘﻪ ﺍﺳﺖ )-P value=0.019(. ﺑﺎ ﺍﻳﻦ ﻭﺟﻮﺩ ﺑﻴﻦ ﻭﺯﻥ ﺍﺑﺘﺪﺍﻱ ﭘﻴﻮﻧﺪ ﻭ ﺳﻪ ﻣﺎﻩ ﭘﺲ ﺍﺯ ﭘﻴﻮﻧﺪ ﺑﺎ ﺁﺯﻣـﻮﻥ Paired t-test ﺩﺭ ﮔﺮﻭﻩ ﭘﻴـﻮﻧﺪ ﻏﻀﺮﻭﻑ ﺑﺎ ﭘﺮﻳﮑﻨﺪﺭﻳﻮﻡ )-P 0.09=value( ﻭ ﮔﺮﻭﻩ ﭘﻴﻮﻧﺪ ﻏﻀﺮﻭﻑ ﺑﺪﻭﻥ ﭘﺮﻳﮑﻨﺪﺭﻳﻮﻡ )0.19=P-value( ﺗﻔﺎﻭﺕ ﻣﻌﻨﺎﺩﺍﺭ ﺁﻣﺎﺭﻱ ﻭﺟﻮﺩ ﻧﺪﺍﺷﺘﻪ ﺍﺳﺖ. ﻧﺘﻴﺠﻪ ﮔﻴـﺮﻱ: ﻏﻀﺮﻭﻑ ﮐﻮﻧﮑﺎﻱ ﺧﺮﺩ ﺷﺪﻩ ﻣﺘﺼﻞ ﺑﻪ ﭘﺮﻳﮑﻨﺪﺭﻳﻮﻡ، ﺍﻣﮑﺎﻥ ﺷﮑﻞ ﺩﺍﺩﻥ ﻭ ﺛﺎﺑﺖ ﻧﻤﻮﺩﻥ ﻣﺠﻤﻮﻋﻪ ﺭﺍ ﻓﺮﺍﻫﻢ ﻣﻲ ﺳﺎﺯﺩ. ﺍﻳﻦ ﺭﻭﺵ ﺭﺍ ﻣﻲ ﺗﻮﺍﻥ ﺑﻌﻨﻮﺍﻥ ﭘﻮﺷﺶ ﺩﺭ ﺑﻴﻨﻲ ﻫﺎﻱ ﺩﺍﺭﺍﻱ ﭘﻮﺳﺖ ﻧﺎﺯﮎ ﻭ ﻳﺎ ﺑﻌﻨﻮﺍﻥ ﮔﺮﺍﻓﺖ ﺑﺮﺍﻱ ﺑﺰﺭﮒ ﮐﺮﺩﻥ ﺩﻭﺭﺳﻮﻡ ﺑﮑﺎﺭ ﮔﺮﻓﺖ. ﺍﮔﺮ ﻗﺼﺪ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﮐﻮﻧﮑﺎ ﺑﺮﺍﻱ ﺑﺰﺭﮒ ﮐﺮﺩﻥ ﺳﺎﺧﺘﻤﺎﻥ ﺑﻴﻨﻲ ﺭﺍ ﺩﺍﺷﺘﻪ ﺑﺎﺷﻴﻢ، ﺑﺎ ﺍﻳﻦ ﺭﻭﺵ ﻣﻲ ﺗﻮﺍﻥ ﻏﻀﺮﻭﻑ ﺿﻌﻴﻒ ﻭ ﻧﺎﻫﻤﻮﺍﺭ ﮐﻮﻧﮑﺎ ﺭﺍ ﺑﻪ ﺍﺑﺰﺍﺭﻱ ﮐﺎﺭﺍﺗﺮ ﺗﺒﺪﻳﻞ ﻧﻤﻮﺩ.

Introduction & Objective: Cartilage graft is frequently used in plastic and reconstructive surgery to overcome bodily and especially facial deformities. One of the problems of this technique is cartilage absorption. Dicing and perichondrial preservation may afford better reconstructive results. Materials & Methods: In this study 28 cartilage specimens from male white New Zealand rabbits, roughly weighing 1500-2000 g and being 12-14 weeks old, were used. After standard induction of general anesthesia in rabbits, two pieces of cartilage were obtained from one ear. Two skin incisions were made on both sides of the midline back of the animal and posterior to the shoulder blades. Then one specimen was diced and inserted on one side. The second piece of the rabbit’s ear was diced in a way that perichondrium was preserved on one side. This specimen was also inserted into a subcutaneous pocket on the other side of the rabbit. After 3 months and by standard sacrifice of the animals, the two specimens were removed and reweighed. Finally the results of standard weighing of the cartilages were compared. Results: The weights of the two groups (cartilage graft with and without perichondrium) were measured at the beginning of the study. They were not significantly different (P-value 0.21). Then the results were compared three months after the operation. That showed a significant (P-value 0.019) increase in the weights of perichondrially attached cartilage compared to the cartilage graft without perichondrium. Nevertheless, using paired t-test at the beginning of the grafting and three month after revealed no significant difference between cartilage graft with perichondrium (P-value 0.09) and cartilage graft without perichondrium (P-value 0.19). Conclusions: Perichondrially attached diced conchal cartilage brings about the possibility of forming and securing the whole complex. This method may be utilized as a cover in thin skinned noses, or as a graft to augment the dorsum. If we intend to use concha to augment nasal structure, by means of this technique, we can change the feeble and convoluted ear cartilage to a more versatile tool.