砧骨搭桥与钛质人工听骨植入在鼓室成形术中的疗效观察

目的:探讨鼓室成形术中自体砧骨搭桥与钛质人工听骨植入的临床疗效。方法:回顾性分析运用自体砧骨搭桥行鼓室成形术的66例非中耳胆脂瘤患者,以及运用钛质人工听骨植入行鼓室成形术的30例中耳胆脂瘤患者的临床资料。术后气-骨导差(ABG)≤20 dB HL视为手术成功标准。随访6~34个月,平均21个月,观察术后并发症,并行听力学疗效分析。结果:96例患者术后6~8周均获干耳,未见外耳道狭窄、肉芽生长、胆脂瘤复发等不良事件;所有病例鼓膜修补膜生长良好,未见再次穿孔和听骨赝复物移位、脱出。自体砧骨组病例手术成功率为77.2%(51/66),3例术后听力改善不明显,1例继发分泌性中耳炎,行鼓膜切开置管后痊愈。钛质人工听骨组病例手术成功率为76.6%(23/30),1例术后听力改善不明显。结论:对于锤骨及镫骨完整、活动度良好,砧骨有不同程度破坏或中断的非中耳胆脂瘤患者,在鼓室成形术中利用自体砧骨搭桥行听骨链重建可获得较好的听力改善;对于锤骨及镫骨底板完整、活动度良好,砧骨、镫骨板上结构有不同程度破坏或中断的中耳胆脂瘤患者,在鼓室成形术中选用钛质人工听骨置植入行听骨链重建可获得较好的听力改善。

Curative effect of incus bypass and titanium artificial ossicle implantation in tympanoplasty

Objective:To explore the clinical effect of implantation of autogenous incus and titanium artificial ossicles in the tympanoplasty.Methods:The data of 66 patients with non-middle ear cholesteatoma and underwent tympanoplasty using autogenous incus,and 30 patients with middle ear cholesteatoma and underwent tympanoplasty using titanium artificial ossicular for the reconstruction of ossicular chain,were retrospectively analyzed.The postoperative air-bone gap(ABG)≤20 dB hearing loss(HL)was regarded as the successful standard of the operation.The follow-up time was 6-34 months,with an average of 21 months.The surgery related complications and the hearing efficacy were analyzed.Results:All 96 patients had dry ears at 6-8 weeks after operation.There were no adverse events such as external auditory canal stenosis,granulation growth,and recurrent cholesteatoma.All cases of tympanic membrane repair film grew well,and perforation,displacement,or dislocation of the ossicular prosthesis was not observed.The success rate of the autogenous incus group was 77.2%(51/66).The hearing improvement was not obvious in 3 cases,and 1 patient with secondary secretory tympanitis was cured after the tympanic membrane incision and catheterization in the autogenous incus group.The success rate of the titanium artificial ossicular group was 76.6%(23/30),and the hearing improvement was not obvious in 1 case.Conclusions:For the non-middle ear cholesteatoma patients with infect and good-activity malleus and stapes while the anvil had different extent of destruction or interruption,the autogenous incus bridge could be used as an alternative method for the reconstruction of the ossicular chain.For the middle ear cholesteatoma patients with complete and good-activity malleus and stapes floor,while the structure of the incus and stapes plate had different degrees of damage or interruption,the titanium artificial ossicles implantation reconstruction could be used as an alternative method for the reconstruction of the ossicular chain.