听骨赝复物标准及传音特性评价的研究进展

本文从外科手术方面和传音的角度阐述了对听小骨假体的要求,同时回顾了评价听小骨假体传音特性的四种方法.     

听骨赝复物实验动物模型的建立及应用

听骨赝复物在临床应用前,都必须经过严格的动物试验。动物模型的建立有助于取得确凿的数据来证明听骨赝复物的优越性。本文总结动物模型的建立以及听骨赝复物相关试验数据的研究现状,为在临床的进一步应用作准备。     

听骨赝复物

随着耳显微外科的迅速发展,鼓室成形术逐渐推广,对听骨链重建材料的研究也逐步深入,现就国内外对听骨链重建材料的研究现状进行综述.     

听骨赝复物

随着耳显微外科的迅速发展，鼓室成形术逐渐推广，对听骨链重建材料的研究也逐步深入，现就国内外对听骨链重建材料的研究现状进行综述。     

部分人工听骨植入位置对中耳传声影响——有限元模型研究

目的　研究部分人工听骨（partial ossicular replacement prosthesis,PORP）植入位置对中耳传声的影响。方法　在去除砧骨的中耳有限元模型上,建立钛金属柱状结构连接锤骨与镫骨的有限元模型,模拟PORP功能。计算锤骨柄不同位置放置PORP,以及软骨片置入PORP和移植筋膜之间对中耳传声的影响。结果　PORP分别置于锤骨颈部、锤骨柄中部和锤骨头去除后的3种情况下,鼓膜脐部振幅于200～8000 Hz均减低,于200～3200 Hz减低大于3200～8000 Hz减低幅度。同样上述3种情况下,镫骨振幅于200～8000 Hz增加,PORP放置于锤骨柄和锤骨颈部基本一致;锤骨头去除后,1000～8000 Hz镫骨振幅较前二者有轻度增高,约2～3 dB。当PORP与鼓膜间置入软骨片时,镫骨底板振动均轻度增强,但不同材料的软骨片差别不大。结论　PORP材料属性和放置位置对实现中耳传声至关重要。     

中耳人工合成听骨赝复物临床应用进展

本综述了目前临床上广泛应用的中耳人工合成赝复物，就赝复物材料的特点，在体内的组织学变化，及其临床应用进行讨论。     

听骨赝复物标准及传音特性评价的研究进展

本从外科手术方面和传音的角度阐述了对听小骨假体的要求，同时回顾了评价听小骨假体传音特性的四种方法。     

脱细胞骨微管用于构建组织工程化听骨赝复物的可行性

目的观察脱细胞骨微管用于制备组织工程化听骨的可能性。方法制备脱细胞骨微管,观察其组织相容性及生物力学变化,并作为含复合骨形态发生蛋白2(bone morphogenetic protein,BMP-2)胶原海绵载体,植入动物中耳空腔,进行异位诱导成骨观察。结果脱细胞骨微管具有良好的生物相容性,其生物力学性能无显著变化。负载含BMP-2胶原海绵后,可以在中耳腔内诱导形成新生骨组织。结论脱细胞骨微管负载含BMP-2胶原海绵可用于构建组织工程化听骨赝复物。     

中耳三维有限元模型的建立与中耳实体模型质量属性分析

目的根据中国健康人体颞骨组织切片数据建立中耳三维有限元模型，分析中耳腔鼓室各组件的几何尺寸，并通过附带软件计算出各听骨的质量属性。方法根据解放军总医院耳鼻咽喉研究所提供的中国正常人颞骨组织切片数据，采用AutoCAD2005、UG软件建立了中耳三维实体模型，在ADINA有限元软件中使用手动和自动法对中耳三维实体模型进行网格划分。依据中耳解剖学、声学及生物力学等研究的文献数据对模型进行生理加载和边界约束，建立了包含鼓膜、听骨、韧带、肌肉的中耳三维有限元模型。最后，利用软件附带功能测量出中耳实体模型大小以及质量属性两方面内容，并与已发表的正常中国人中耳解剖结构的测量数据比较验证其结果的几何相似性和可靠性。结果重建了包含鼓膜、听骨、韧带、肌肉的中耳三维有限元模型。从测量中耳实体模型大小以及质量属性两方面的数据证实了此中耳三维有限元模型能良好的模拟正常人体中耳鼓室形态结构，具有良好的几何相似性。结论应用本方法建立的正常人中耳腔三维有限元模型形态逼真，几何相似性好，为进一步的从声学、生物动力学方面测试此模型在不同频率特定声压作用下鼓膜及镫骨的振动反应、中耳传音结构的几何形态及负荷改变奠定了形态学基础。     

Functional results of Plastipore prostheses for middle ear ossicular chain reconstruction.

OBJECTIVE: Assessment of plastipore prostheses for middle ear ossicular chain reconstruction. Hearing results with total and partial Plastipore ossicular replacement prostheses (TORP and PORP) were evaluated in open- and closed-cavity operations. STUDY DESIGN: A retrospective review of 237 patients who underwent operation for chronic ear disease as well as ossiculoplasty with plastipore prostheses. In order to assess the functional results, only 156 of 237 patients were included in the study. Follow-up ranged from 6 to 46 months. METHODS: Canal wall up and canal wall down operations were performed. Either TORP or PORP ossiculoplasty was performed in each operation. An airbone gap closure to within 20 dB was considered successful. RESULTS: With TORPs, the airbone gap closure to within 20 dB was achieved in 43.1%, and similar results were obtained with PORPs in 63.3%. In canal wall down and canal wall up operations, the success rates were 55.8% and 55.7%, respectively. The best results were obtained with PORPs in canal wall down operations, with a success rate of 82%. The extrusion rate of the prostheses was 4.2%. CONCLUSION: Hearing results of PORPs are better than TORPs. In canal wall up and canal wall down operations similar hearing results are obtained. PORP ossiculoplasty in a canal wall down operation yields the most favorable hearing result.     

Optimum tension for partial ossicular replacement prosthesis reconstruction in the human middle ear

OBJECTIVE: Hearing results from ossiculoplasty are unpredictable. There are many potentially modifiable parameters. One parameter that has not been adequately investigated in the past is the effect of tension on the mechanical functioning of the prosthesis. Our goal was to investigate this parameter further, with the hypothesis that the mechanical functioning of partial ossicular replacement prostheses (PORP) from the stapes head to the eardrum will be affected by the tension that they are placed under. METHODS: Fresh temporal bones were used to reconstruct a missing incus defect with a PORP-type prosthesis. Three different lengths of PORP were used, and the stapes vibrations were measured with a laser Doppler vibrometer using a calibrated standard sound in the ear canal. Eight temporal bones were used. RESULTS: Tension had a very significant effect on stapes vibration. In general, loose prostheses resulted in the best overall vibration transmission. The effects were most marked at the lower frequencies. There was a slight advantage to tight prostheses in the higher frequencies, but much less than the decrement in lower frequencies with tight prostheses. CONCLUSION: In ossicular reconstruction, best stapes vibration results in our model are achieved by shorter prostheses, which result in lower tension.     

新型HA-BMP复合人工听小骨临床应用观察

目的：对一种新型HA-BMP复合人工听小骨临床应用的效果进行评价。方法：对2000-2005年进行鼓室成形术的59例（61耳）患者进行随访。使用HA-BMP复合人工听小骨行鼓室成形术的26耳,其中全听骨赝复物7耳,部分听骨赝复物19耳;使用自体残余听骨重建者18耳;单纯大鼓室Ⅲ型手术17耳。结果：平均随访时间31.2个月;使用新型HA-BMP复合人工听小骨者的听力提高明显优于使用自体组织重建听骨链和单纯大鼓室Ⅲ型手术患者（均P〈0.01）,结果按照术后平均语频气骨导差小于20 dB为成功标准,HA-BMP复合人工听小骨组成功率为92.3%,随访均未见听骨脱出。结论：新型HA-BMP复合人工听小骨具有良好的生物相容性和优异的传音性能,明显优于自体组织,临床应用效果稳定,具有广泛的应用前景。     

不同部位鼓室骨瘤临床特征分析

目的:探讨不同部位鼓室骨瘤患者的临床特征以及干预、治疗方法。方法:回顾总结2例不同部位鼓室骨瘤患者的临床资料,包括病史、听力学及影像学检查、手术方案和随访结果,结合国内外文献报道的36例鼓室骨瘤患者的临床特征、治疗方式及疗效进行总结分析。结果:本研究收集的2例鼓室骨瘤患者病变分别来源于中鼓室的鼓岬和砧骨,均无明显的病因...     

不同类型先天性中耳畸形的手术治疗

探讨先天性中耳畸形的临床分型及其手术策略。方法选取2016年6月—2019年12月收治的23例（33耳）先天性中耳畸形患者进行中耳畸形临床分型及不同的手术策略进行回顾分析,观察术后疗效和听力的恢复情况。术前对23例（33耳）中耳畸形患者均行耳内镜检查、听力学检查及颞骨CT并听骨链三维重建检查。结果23例患者中18例为术前明确畸形,5例为术中探查发现畸形。其中15例为锤、砧骨畸形,选择人工听骨赝复物（TORP或PORP）或自体听骨植入修复;6例为镫骨畸形,选择人工镫骨赝复物（Piston）植入;1例为鼓膜穿孔伴有先天性中耳畸形,先行鼓膜成形术,二期行听骨链重建手术;1例畸形程度比较复杂,面神经走形异常,在前庭窗处分叉,遮挡前庭窗,未能行进一步治疗。术后气导阈值提高至正常的有15例（65.2%）;骨气导差（ABG）恢复至30 dB以内的有16例（69.6%）,ABG术后仍超过30 dB的有5例（21.7%）,1例听力未改善（4.3%）,1例无法行听骨重建（4.3%）。结论先天性中耳畸形术前诊断比较困难,CT检查很难精确评估,手术探查为最有说服力的诊断标准,明确中耳畸形临床分型后选择最佳的手术方式,是治愈疾病并提高患者术后听力最佳选择。     

新鲜颞骨模型建立在中耳传声机制研究中的作用

目的探讨中耳传声机制研究中的中耳模型建立,为深入研究中耳传声机制,指导耳外科手术,尤其在听骨链重建方面建立一个接近活体情况的研究模型。方法采用17例新鲜尸体颞骨标本,利用激光多普勒振动仪,在声刺激和不同强度的机械刺激下,研究了鼓膜和镫骨底板的运动。结果鼓膜和镫骨底板的运动与活体测量的数据接近。结论新鲜颞骨标本可以用于不同方面中耳传声机制的研究。在鼓膜脐部的电机械刺激可以模仿声刺激。     

Standardized measurements of the sound transmission of middle ear implants using a mechanical middle ear model

Several ways to evaluate the sound transmission properties of middle ear implants are now established. Besides computer-based simulations using acoustic and electrical analog circuits or finite element analysis, measurements can be performed with temporal bone preparations. Experiments with these preparations consider various anatomical properties, but a large number of parameters influence the outcome of measurements. To facilitate standardized measurements, a mechanical middle ear model was developed that allows comparison of the transfer function of middle ear implants on defined conditions. The model approximates the impedances of the tympanic membrane and inner ear with the aid of thin, flexible membranes. The implants are fit between the membranes, and displacement at an artificial stapes footplate is measured with an optical probe. Fundamental influences on the sound transmission properties of nine different middle ear implants (total ossicular replacement prostheses) were examined. Although the material and shape were different, some of the prostheses revealed very similar transfer functions. The mass of the implant showed the largest influence on sound conduction. With a higher mass, the frequency area above approximately 1 kHz was found to be significantly deteriorated. The lightest implant used was 4 mg and showed the best overall results. These findings show that middle ear prostheses should be as light as possible for optimum high-frequency transmission. Received: 24 May 1998 / Accepted: 9 July 1998     

The development of the ossicular ligaments in the human middle ear

Summary We examined serially sectioned human temporal bones of fetuses and newborns from Wittmaack's temporal bone collection at the University of Hamburg. At the end of the 3rd month of fetal development, a concentration of mesenchyme arises in the area which later contains the ossicular ligaments. The anlage of these ligaments can be clearly identified in the 4th month of development. The longitudinal axis of the cells in this anlage first runs parallel with the surface of the ossicles. In the further stages of development with increasing fibrillogenesis the cells straighten out according to the physiological stresses. Differentiation of the ligaments is terminated at the end of the 9th month.     

鼓膜微型管置入术治疗中耳不张的临床观察

目的 探讨鼓膜微型管植入术治疗中耳不张的临床疗效.方法 回顾分析26例(28耳)中耳不张的患者,以耳闷为主诉;耳镜检查见鼓膜内陷、光锥散乱或消失、鼓膜苍白无光泽;纯音测听气骨导差＞ 10 dB;声导抗鼓室负压;中耳不张分级Ⅰ～Ⅲ级.患者局麻下行鼓膜微型管置入术,术后随访6 ～12个月.结果 25耳术后耳闷症状消失,其中23耳微型管取出后2周声导抗检查提示鼓室压图由C型恢复为A型,平均听阈下降5 ～20 dB;2耳取管后1个月复发,耳闷症状和中耳负压重新出现.3耳置管失败或耳闷无改善,均为中耳不张Ⅲ级.26例患者取管后2周鼓膜均良好愈合,未出现感染、鼓膜穿孔等并发症.结论 鼓膜微型管置入术能有效解除鼓室负压,缓解耳闷,可用于Ⅰ～Ⅱ级中耳不张的治疗.