耳廓血肿和菜花耳的评估与处理
- Author
- Kelly Michele Malloy, MD
Kelly Michele Malloy, MD
- Associate Professor
- Department of Otolaryngology - Head and Neck Surgery
- University of Michigan Medical School
- Section Editors
- Anne M Stack, MD
Anne M Stack, MD
- Section Editor — Pediatric Procedures
- Associate Professor, Department of Pediatrics
- Harvard Medical School
- Allan B Wolfson, MD
Allan B Wolfson, MD
- Section Editor — Adult Procedures
- Professor of Emergency Medicine
- University of Pittsburgh
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
- Translators
- 丛铁川, 主治医师
丛铁川, 主治医师
- 北京大学第一医院耳鼻咽喉-头颈外科
引言
耳廓血肿通常由运动(如业余摔跤、英式橄榄球、拳击或综合武术)中耳廓(外耳)所受的钝挫伤所致。该种损伤须行立即引流，并采取相关措施预防血液再次积聚。当耳廓血肿没有充分引流、复发或未进行治疗时，会发生耳廓纤维软骨过度生长，导致菜花耳这一永久畸形(图片 1)。
本专题将总结耳廓血肿的评估与处理，着重于能避免菜花耳这一远期并发症的最佳方法。耳廓(耳)撕裂伤的评估与处理将单独讨论。 (参见“Assessment and management of auricle (ear) lacerations”)
解剖与病理生理
外耳向外突出这一独特特征使它尤其易受到创伤。耳廓的软骨性结构包括耳轮、对耳轮、耳甲、耳屏和对耳屏(图 1)[1]。耳垂由纤维脂肪组织构成，不含软骨。覆盖于耳廓软骨的皮肤纤薄，没有明显的皮下脂肪组织，紧密贴附于其下的软骨膜。软骨膜给耳廓软骨提供营养。
发生创伤性血肿时，血液蓄积于软骨膜下间隙(位于软骨膜和软骨之间)。蓄积的血液形成了软骨和软骨膜血供之间的机械性屏障[1]。由于失去血液灌注，其下的软骨坏死，还可能发生感染。这些病理变化导致软骨丢失，继而发生纤维化和新软骨形成。这一愈合过程是无序的，导致形成菜花耳这一美观畸形(图片 1)。早期引流血肿并将软骨膜层复位到其下的软骨上，可恢复对软骨的灌注并降低形成菜花耳的可能性。
损伤机制
耳廓血肿和菜花耳是常见的运动损伤。虽然流行病学数据缺乏，但英式橄榄球、拳击、摔跤和综合武术或“终极格斗”等是通常与这些损伤有关的运动。未佩戴头部护具的搏斗人员受伤风险更高。例如，一项针对大学摔跤手的调查研究发现，耳部外伤更常见于未戴头部护具的摔跤手(耳廓血肿分别为52% vs 26%，菜花耳分别为27% vs 11%)[2]。患耳廓血肿的搏斗人员亦倾向于忽视这种损伤，并且即使得到治疗，他们仍面临再次损伤并最终形成菜花耳的风险[3]。
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To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:Literature review current through: 2017-06 . | This topic last updated: 2015-09-09.The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.References- Greywoode JD, Pribitkin EA, Krein H. Management of auricular hematoma and the cauliflower ear. Facial Plast Surg 2010; 26:451.
- Schuller DE, Dankle SK, Martin M, Strauss RH. Auricular injury and the use of headgear in wrestlers. Arch Otolaryngol Head Neck Surg 1989; 115:714.
- Roy S, Smith LP. A novel technique for treating auricular hematomas in mixed martial artists (ultimate fighters). Am J Otolaryngol 2010; 31:21.
- Riviello RJ, Brown NA. Otolaryngologic procedures. In: Clinical Procedures in Emergency Medicine, 5th edition, Roberts JR, Hedges JR. (Eds), Saunders Elsevier, Philadelphia, PA 2010. p.1178.
- Jones SE, Mahendran S. Interventions for acute auricular haematoma. Cochrane Database Syst Rev 2004; :CD004166.
- Martinez NJ, friedman MJ. External ear procedures. In: Textbook of Pediatric Emergency Procedures, 2nd edition, King C, Henretig FM. (Eds), Lippincott, Williams & Wilkins, Philadelphia, PA 2008. p.593.
- Brickman K, Adams DZ, Akpunonu P, et al. Acute management of auricular hematoma: a novel approach and retrospective review. Clin J Sport Med 2013; 23:321.
- Giles WC, Iverson KC, King JD, et al. Incision and drainage followed by mattress suture repair of auricular hematoma. Laryngoscope 2007; 117:2097.
- Kakarala K, Kieff DA. Bolsterless management for recurrent auricular hematomata. Laryngoscope 2012; 122:1235.
- Ghanem T, Rasamny JK, Park SS. Rethinking auricular trauma. Laryngoscope 2005; 115:1251.
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