外伤性听骨链中断和脱位的诊断及治疗

目的:探讨常见外伤性听骨链中断和脱位的诊断治疗及术后疗效。方法:8例(8耳)外伤性听骨链中断,其中6例为单侧传导性聋,2例混合性聋且以传导性为主;8耳均行鼓室探查,并行听骨链重建术,其中1耳行全听骨(TORP)重建术,4耳行部分听骨(PORP)重建术,2耳行听骨链复位,1耳用人工砧骨重建,通过术前术后气骨导差比较疗效。结果:术前听力检查示平均气骨导差为42.9dB,术后3周平均气骨导差为22.3dB,较术前缩小20.6dB(t=22.10,P<0.01),术后6～8个月平均气骨导差为18.6dB,较术前缩小24.3dB(t=12.813,P<0.01)。结论:外伤性听骨链中断或脱位引起的传导性听力下降,根据术中情况采用不同听骨链重建术可以明显提高听力,治疗首选手术。

Diagnosis and treatment of traumatic ossicular chain disruption and dislocation

Objective:To investigate the diagnose therapy and the postoperative curative effect of traumatic ossicular chain disruption and dislocation.Method:Eight cases(8 ears) with traumatic ossicular chain disruption.Six cases of unilateral conductivity deafness,2 of mixed deafness still with conductive primarily.Eight ears all were performed tympanic exploration and ossicular replacement prosthesis,1 ear with TORP(total ossicular replacement prosthesis),4 ears with PORP(partial ossicular replacement prosthesis),2 with ossicular chain reset,1 with artificial incus reconstruction.The treatment effect was compared by the preoperative and postoperative ABG(air bone gap).Result:Preoperative average ABG was 42.9 dB,the average ABG 3 weeks after operation was 22.3 dB,which reduced 20.6 dB compared to the preoperative,having a statistically significant difference(t=22.10,P<0.01).The average ABG was 18.6 dB 6-8 months after operation,which reduced 24.3 dB compared to the preoperative,having a statistically significant difference(t=12.813,P<0.01).Conclusion:The conductivity hearing loss after traumatic ossicular chain disruption or dislocation is preferred operation treatment,and replacement should use different ways according to the operation in case,and the hearing improvement was obvious.