CAJ | 학술논문

目的分析采用自体带骨膜的骨皮质片修复根治后缺损的耳道壁并同期作听骨重建的初步结果 .方法手术病例23例,男11例,女12例,年龄19～72岁,均为开放式乳突根治手术后遗有巨大根治腔和感染流脓,术前平均气导为(63.43±15.57)dB,平均气骨导差(43.04±7.66)dB.耳后切口,按欲取骨片大小(直径约为2cm)切开骨膜并分离之,骨膜仍与骨片中央保持连接.用铣钻、摆锯及平凿凿下,修整后植入根治腔,修复缺损的外耳道、鼓窦壁.9例有镫骨存在,作臼柱自体听骨重建;10例仅存足板者,作枪柱自体听骨重建;4例因各种原因未同时处理听骨.统计分析采用U检验.结果 23例全部获得乳突腔封闭,耳道呈现光滑的外观.4例CT复查见上鼓室和乳突腔再气化.术后平均气导为(51.78±12.77)dB HL,3月后随访为(43.0±16.40)dB HL.气骨导差(gap)为(33.08±7.63)dB,与术前相比,P<0.05;随访gap为(23.48±8.71)dB,与术前相比,P<0.01;与术后相比,P<0.05,差异均有显著意义.11例随访gap<20 dB,1例随访gap>20 dB,但gap缩小>30 dB,此12例为成功,占52%.5例gap<10 dB,2例虽>10 dB,但差值>30 dB,这7例为显效,占33%.15例gap缩小15 dB以上,为有效(71%).4耳遗留穿孔.结论带骨膜骨片与髂骨填塞及人工材料相比较,能更快愈合且保留固有的乳突空腔,形成正常光滑的耳道,也有利于听力恢复.
목적 분석채용자체대골막적골피질편수복근치후결손적이도벽병동기작은골중건적초보결과 .방법 수술병례23례,남11례,녀12례,년령19～72세,균위개방식유돌근치수술후유유거대근치강화감염류농,술전평균기도위(63.43±15.57)dB,평균기골도차(43.04±7.66)dB.이후절구,안욕취골편대소(직경약위2cm)절개골막병분리지,골막잉여골편중앙보지련접.용선찬、파거급평착착하,수정후식입근치강,수복결손적외이도、고두벽.9례유등골존재,작구주자체은골중건;10례부존족판자,작창주자체은골중건;4례인각충원인미동시처리은골.통계분석채용U검험.결과 23례전부획득유돌강봉폐,이도정현광활적외관.4례CT복사견상고실화유돌강재기화.술후평균기도위(51.78±12.77)dB HL,3월후수방위(43.0±16.40)dB HL.기골도차(gap)위(33.08±7.63)dB,여술전상비,P<0.05;수방gap위(23.48±8.71)dB,여술전상비,P<0.01;여술후상비,P<0.05,차이균유현저의의.11례수방gap<20 dB,1례수방gap>20 dB,단gap축소>30 dB,차12례위성공,점52%.5례gap<10 dB,2례수>10 dB,단차치>30 dB,저7례위현효,점33%.15례gap축소15 dB이상,위유효(71%).4이유류천공.결론 대골막골편여가골전새급인공재료상비교,능경쾌유합차보류고유적유돌공강,형성정상광활적이도,야유리우은력회복.
Objective To report outcomes of rebuilding the posterior ear canal wall with periosteam-boned plank for tympanoplasty following radical mastoidectomy.Methods Twenty three patients(12 females and 11 males,aged 19-72 years ) were treated for infected mastoidectomy cavities and conductive deafness.The pre-operative mean air conduction(AC)threshold was(3.43±15.57)dB HL,with an average air-bone gap(ABG)of(43.04±7.66)dB.Autogenous periosteam-boned-planks were harvested via a postauricular incision.A thin layer of periosteam (about 1 mm)was exposed and cut in the donor area(usually 2 cm in diameter).With the central part of the periosteum left attached to the cortical bone underneath,the bone graft was harvested using a milling cutter,a craniotome and a fiat-chisel.The harvested bone-plank.was then sculptured to fit in the ear-canal wall deficit.The ossicular chain was reconstructed with cupshaped bone autograft in 9 ears and with right-angled prosthesis in 10 cases.Primary ossicular chain reconstruction was not perfbrmed in 4 ears for various reasons.The U test was used in statistical analyses.Results The mastoidectomy cavity was successfully obliterated with a smooth ear-cananl wall in all 23 cases.Followed uD CT scans demonstrated repneumotization of the mastoid and epitympanum in 4 cases.Mean AC was(51.78±12.77)dB HL postoperatively and(43.0±16.40)dB HL at follow up.Compared to before surgery,the ABG was reduced to(33.08±7.63)dB postoperatively(P<0.05)and to(23.48±8.71)dB at follow up(P<0.01)which was also better than immediately after surgery(P<0.05).Treatment was considered completely successful in 12 cases(52%)at the time of follow up with the ABG reduced to<20 dB in 11 of these cases.While ABG remained>20 dB in one of the 12 cases.it had been reduced by more than 30 dB.Treatment resulted in significant improvement in 7 cases(33%)at follow up with ABG reduced to<10 dB in 5 of these cases.In 2 of the 7 cases,while the ABG was>10 dB,it had been reduced by more than 30 dB.Treatment was considered effective in 15 cases(71%)with an ABG reduction of 15 dB or more.Postoperative perforation was found in 4patients.Conclution Periosteam-bone-plank appears to be a viable option for posterior ear canal reconstruction following radical mastoidectomy.The technique can facilitate middle ear re-aerification,and hearing restoration.