CAJ | 학술논문

目的探讨虚拟耳镜对鼓膜完整的外伤性听骨链中断手术前后的评估作用.方法采用高分辨螺旋CT轴位、斜冠状位颞骨扫描,应用虚拟耳镜软件,对选取的17例颞骨骨折患者和4例鼓膜钝挫伤患者进行图像三维重建.10例砧骨脱位或脱落经完壁式上鼓室进路听骨复位术;11例砧骨长脚断裂或脱位伴面神经麻痹则行听骨链成形术和面神经减压术.有9例患者术后复查虚拟耳镜.结果 17例颞骨骨折外伤性听骨链中断,其中砧骨长脚断裂3例,砧骨脱位9例,砧骨脱落5例;4例鼓膜钝挫伤砧骨脱位2例,砧骨脱落2例.颞骨CT显示骨折线和锤砧骨不规整.虚拟耳镜清楚显示锤砧关节与砧镫关节脱位,砧骨脱落或骨折,可见砧骨长脚与镫骨分离,砧骨体移位.手术证实,砧骨体脱出向后移位并有软组织包裹,砧骨长脚与镫骨之间软组织相连或分离.鼓膜顿挫伤术中见砧骨脱落呈外翻状.手术后3～6个月复查,虚拟耳镜见砧骨脱位者听骨链恢复接近正常,砧骨脱落者听骨连接完整.术后患耳听力明显提高达实用听力水平.外伤性听骨链中断的虚拟耳镜观察与手术证实符合率为100%.结论虚拟耳镜为准确评估外伤性听骨链中断,确立个体化手术方案和术后随访提供可靠的直观依据.
목적 탐토허의이경대고막완정적외상성은골련중단수술전후적평고작용.방법채용고분변라선CT축위、사관상위섭골소묘,응용허의이경연건,대선취적17례섭골골절환자화4례고막둔좌상환자진행도상삼유중건.10례침골탈위혹탈락경완벽식상고실진로은골복위술;11례침골장각단렬혹탈위반면신경마비칙행은골련성형술화면신경감압술.유9례환자술후복사허의이경.결과 17례섭골골절외상성은골련중단,기중침골장각단렬3례,침골탈위9례,침골탈락5례;4례고막둔좌상침골탈위2례,침골탈락2례.섭골CT현시골절선화추침골불규정.허의이경청초현시추침관절여침등관절탈위,침골탈락혹골절,가견침골장각여등골분리,침골체이위.수술증실,침골체탈출향후이위병유연조직포과,침골장각여등골지간연조직상련혹분리.고막돈좌상술중견침골탈락정외번상.수술후3～6개월복사,허의이경견침골탈위자은골련회복접근정상,침골탈락자은골련접완정.술후환이은력명현제고체실용은력수평.외상성은골련중단적허의이경관찰여수술증실부합솔위100%.결론 허의이경위준학평고외상성은골련중단,학립개체화수술방안화술후수방제공가고적직관의거.
Objective To evaluate the clinical use of virtual endoscopy in the traumatic ossicular chain disruption with intact tympanum pre- and post-operation.Methods The seriesconsisted of 17 cases with temporal bone fracture and 4 cases with tympanum contusion.All were examinated with a high resolution spiral CT by axial and oblique coronal planes of the temporal bone.Three-dimensional reconstruction was processed using the virtual endoscopy software.Ten cases of traumatic ossicular chain disruption were performed with intact canal wall epitypanum approach Ossicular reposition.Eleven patients with facial paralysis were performed ossiculoplasty and facial nerve decompression. Nine cases re-examinated virtual endoscopy after operation.Results Seventeen cases with temporal bone fractures and traumatic ossicular chain disruption,including 3 cases with the long process of the incus fracture,9 cases with incus bone dislocation,and 5 cases with incus shedding.In the 4 cases of tympanum contusion,2 cases with incus bone dislocation,2 cases with incus bone shedding.The axial plane of temporal bone CT could only showed the fracture line and the hammer and incus bone irregular shape.Perioperatively virtual endoscopy showed hammer incus joint separation,incus stirrup dislocation and joint deformation.Surgery confirmed that the incus body was torn off below the hammer following bone displacement,soft tissue wrapped articular surface,incus and stapes just connected with soft tissue.During the tympanum contusion operation could see incus bone-shedding was valgus.Three to six months after surgery,re-examinated virtual endoscopy showed incus bone dislocation ossicular chain Was restored to normal,temporal bone shedding ossicular chain connecting almost intact.Hearing increased significantly to the level of practical hearing.The coincidence of traumatic disruption of the ossicular chain by virtual endoscopy and surgery was 100%.Conclusion Virtual endoscopy was valuable for providing accurate assessment and individual program for treating and following-up the traumatic ossicular chain disruption.