自体骨重建听骨链在开放式乳突根治术中的应用

目的探讨自体骨重建听骨链在开放式乳突根治术中的应用价值及疗效。方法回顾分析37例38耳术后病理检查确诊为慢性化脓性中耳炎和胆脂瘤中耳炎患者的临床资料。结果所有病例术后随访观察6～24个月,干耳时间平均为6周,3个月内干耳率为92.1%(35/38)。所有患者术后纤维耳内镜检查见术腔光滑,上皮化好,鼓膜形态良好,与鼓室无粘连,无内陷袋形成。术后6个月行纯音测听检查,术后听力提高至应用水平(30 dB)以上者23耳(23/38),占60.5%;术后听力提高10 dB,但未到应用水平8耳(8/38),占21%,总提高率为81.5%,其余7耳听力无改变或稍有下降。术后语言频率(0.5-2kHz)气骨导差较术前缩小平均约20 dB。结论在开放式乳突根治术中采用自体骨重建听骨链并1期鼓室成形术,有助于挽救或改善听力;且自体锤骨或砧骨体取材方便、易塑形、组织相容性好,并能节省费用,是开放式乳突根治术中重建听骨链的理想材料。

The application of obliteration with bone pate and reconstruction of ossicular chain with autogenous bone in open radical mastoidectomy

Objective To explore the application and effect of obliteration with bone pate from mastoid cortex and reconstruction of ossicular chain with autogenous bone in open radical mastoidectomy. Methods Clinical data of 37 ears in 36 cases with chronic suppurative otitis media and cholesteatoma confirmed by postoperative pathological examination were retrospectively analyzed. Results All cases were followed up for 6- 24 months, average time of dry ear time is 6 weeks, the rate of dry ear in 3 months was 92.1% （35/38）. The post - operative cavity was significantly reduced in all patients under fiber endoscopy;the cavity is smooth with good epithelization, tympanic membrane in good shape, no adhesion and tympanic, no retraction pocket formation. 6 months later after operation, the pure tone audiometry was tested, postoperative hearing level increased to the application level （30 dB） in 23 ears （23/38）, accounting for 60.5 % ;postoperative hearing level increased by 10 dB, but not to the application level in 8 ears （8/38） , accounting for 21%. The total improve rate was 81.5% ; the remaining 7 ears hearing no change or decrease slightly. The post -operative average air -bone gap in speech area frequency （0.5 -2kHz）reduced about 20 dB. Conclusion Obliteration with bone pate from mastoid cortex and reconstruction of ossicular chain with autogenous bone and 1 stage tympanoplasty help to repair the left cavity, help save or improve the hearing; on the other hand, bone pate from mastoid cortex and autogenous bone is easy to obtain and shape, and has good histocompatibility and less rejection. So it is a kind of ideal material in open radical mastoidectomy.