中华耳鼻咽喉头颈外科杂志
中華耳鼻嚥喉頭頸外科雜誌
중화이비인후두경외과잡지
CHINESE JOURNAL OF OTORHINOLARYNGOLOGY HEAD AND NECK SURGERY
2008年
10期
746-750
,共5页
砧骨%听小骨假体%鼓室成形术
砧骨%聽小骨假體%鼓室成形術
침골%은소골가체%고실성형술
Incus%Ossicular praosthesis%Tympanoplasty
目的 探讨自体砧骨搭桥术在听骨链重建中的临床应用效果.方法 回顾性分析68例自体砧骨搭桥听骨链重建患者,随访时间6～28个月,平均19.75个月.将自体砧骨塑形后桥接于完整的锤骨和完整活动的镫骨之间.观察术后并发症并行听力学疗效分析.结果 术后无1例自体砧骨脱出,2例移位.平均纯音听力(pure tone average,PTA)的气导由术前(46.69±18.32)dB提高到(30.21±9.46)dB,骨导由(24.72±10.63)dB提高到(18.15±8.91)dB,气骨导差(air-bone gap,ABG)由(21.97±10.32)dB缩小到(12.06±9.46)dB.手术成功率(术后PTA-ABG≤20 dB)为75%,术后骨导听力改善阳性率为66%(0.5、1、2、4 kHz中至少有2个频率提高10 dB).筛选出随访在1年以上的50例患者,术后6个月PTA-ABG≤20 dB占78%,1年为74%,最近1次为72%.结论 当修复完整、活动的镫骨和完整锤骨之间的听骨链缺损时,采用自体砧骨搭桥因为操作便利,费用低廉,效果稳定,并发症少,听力恢复理想,在自体砧骨可以利用时应当视为首选.对其手术效果的听力评价除以术前、术后气骨导差的闭合程度为依据外,也应考虑术前、术后气导、骨导.
目的 探討自體砧骨搭橋術在聽骨鏈重建中的臨床應用效果.方法 迴顧性分析68例自體砧骨搭橋聽骨鏈重建患者,隨訪時間6～28箇月,平均19.75箇月.將自體砧骨塑形後橋接于完整的錘骨和完整活動的鐙骨之間.觀察術後併髮癥併行聽力學療效分析.結果 術後無1例自體砧骨脫齣,2例移位.平均純音聽力(pure tone average,PTA)的氣導由術前(46.69±18.32)dB提高到(30.21±9.46)dB,骨導由(24.72±10.63)dB提高到(18.15±8.91)dB,氣骨導差(air-bone gap,ABG)由(21.97±10.32)dB縮小到(12.06±9.46)dB.手術成功率(術後PTA-ABG≤20 dB)為75%,術後骨導聽力改善暘性率為66%(0.5、1、2、4 kHz中至少有2箇頻率提高10 dB).篩選齣隨訪在1年以上的50例患者,術後6箇月PTA-ABG≤20 dB佔78%,1年為74%,最近1次為72%.結論 噹脩複完整、活動的鐙骨和完整錘骨之間的聽骨鏈缺損時,採用自體砧骨搭橋因為操作便利,費用低廉,效果穩定,併髮癥少,聽力恢複理想,在自體砧骨可以利用時應噹視為首選.對其手術效果的聽力評價除以術前、術後氣骨導差的閉閤程度為依據外,也應攷慮術前、術後氣導、骨導.
목적 탐토자체침골탑교술재은골련중건중적림상응용효과.방법 회고성분석68례자체침골탑교은골련중건환자,수방시간6～28개월,평균19.75개월.장자체침골소형후교접우완정적추골화완정활동적등골지간.관찰술후병발증병행은역학료효분석.결과 술후무1례자체침골탈출,2례이위.평균순음은력(pure tone average,PTA)적기도유술전(46.69±18.32)dB제고도(30.21±9.46)dB,골도유(24.72±10.63)dB제고도(18.15±8.91)dB,기골도차(air-bone gap,ABG)유(21.97±10.32)dB축소도(12.06±9.46)dB.수술성공솔(술후PTA-ABG≤20 dB)위75%,술후골도은력개선양성솔위66%(0.5、1、2、4 kHz중지소유2개빈솔제고10 dB).사선출수방재1년이상적50례환자,술후6개월PTA-ABG≤20 dB점78%,1년위74%,최근1차위72%.결론 당수복완정、활동적등골화완정추골지간적은골련결손시,채용자체침골탑교인위조작편리,비용저렴,효과은정,병발증소,은력회복이상,재자체침골가이이용시응당시위수선.대기수술효과적은력평개제이술전、술후기골도차적폐합정도위의거외,야응고필술전、술후기도、골도.
Objective To study the clinical effects of bridging operation by an autogenous incus in the ossiculoplasty. Methods All the postoperative follow-up data of the 68 patients were analyzed retrospectively, who underwent bridging operation by an autngenous incus in the ossiculoplasty and were followed up for 6-28 months with an average of 19. 75 months. The autogenous incus which had been reshaped was implanted between the intact malleus and the intact mobile stapes. The preoperative and postoperative pure tone average (PTA) air-conduction, bene-conductian and air-bone gap on four frequencies (0. 5, 1,2 and 4 kHz) were calculated and analyzed. Results No postoperative autogenous incudes were extruded with only two cases displaced. The pure tone air conduction improved from a preoperative average of (46. 69±18. 32 )dB to a postoperative average of ( 30. 21±9. 46 ) dB, while bone conduction improved from a preoperative average of ( 24. 72±10. 63 )dB to a postoperative average of (18. 15±8.91) dB, as well as air-bone gap closed from a preoperative average of 21.97±10. 32 dB to a postoperative average of (12. 06±9. 46) dB. The success rate (postoperative PTA-ABG≤20 dB) occurred in 75% of all the cases. The improvement of the bone conduction occurred in 66% of all the cases, at least with 10 dB occurred in at least two frequencies. Conclusions Because of low expenses, high convenience in an operation, high stability in effects , very low complications and excellent hearing results for the patients, the bridging operation as stated in the above was worthy of choice. The autogenous incus could be utilized if the defects between the intact, mobile stapes and the intact malleus could be well repaired.
