CAJ | 학술논문

目的分析自体软骨在慢性化脓性中耳炎、中耳胆脂瘤听力重建手术中的应用及疗效。方法回顾性分析165例（173耳）采用自体软骨行听力重建的中耳手术患者的临床资料，其中单纯鼓膜穿孔43例（48耳），中耳胆脂瘤61例（61耳），鼓室硬化23例（23耳），慢性化脓性中耳炎伴肉芽38例（41耳）。自体软骨材料用于修补鼓膜133例（139耳），用于人工听骨赝复物上衬垫102例（104耳），用于上鼓室、鼓窦重建31例（31耳），用于外耳道后壁重建3例（3耳）。比较患者术前、术后1年随访时0．5、1、2、4 kHz的纯音平均听阈、平均气骨导差及局部修复成功率。结果鼓膜修补的133例139耳中，136耳修补成功，3耳出现移植物边缘小穿孔，一期鼓膜修补成功率97．84％（136/139）；听骨链重建的102例（104耳）中，无听骨赝复物脱出病例；31例（31耳）上鼓室、鼓窦重建的患者中，局部未见内陷、移位；3例（3耳）外耳道修复的患者未见外耳道后壁塌陷。43例（48耳）单纯鼓膜修补的患者术前、术后气骨导差分别为23．8±3．1和11．6±8．7 dB。61例（61耳）中耳胆脂瘤患者术前、术后气骨导差分别为39．2±24．7和19．0±12．1 dB。23例（23耳）鼓室硬化的患者术前、术后气骨导差分别为31．2±12．4和19．8±11．2dB。38例（41耳）慢性化脓性中耳炎伴肉芽患者术前、术后气骨导差分别为41．6±9．9和15．3±13．4dB。结论自体软骨在听力重建手术中应用价值大，特别适合于鼓膜复杂性穿孔、复发性穿孔的修复，有利于听骨链假体的固定及上鼓室、乳突术腔及骨性外耳道缺损修复。
목적분석자체연골재만성화농성중이염、중이담지류은력중건수술중적응용급료효。방법회고성분석165례（173이）채용자체연골행은력중건적중이수술환자적림상자료，기중단순고막천공43례（48이），중이담지류61례（61이），고실경화23례（23이），만성화농성중이염반육아38례（41이）。자체연골재료용우수보고막133례（139이），용우인공은골안복물상츤점102례（104이），용우상고실、고두중건31례（31이），용우외이도후벽중건3례（3이）。비교환자술전、술후1년수방시0．5、1、2、4 kHz적순음평균은역、평균기골도차급국부수복성공솔。결과고막수보적133례139이중，136이수보성공，3이출현이식물변연소천공，일기고막수보성공솔97．84％（136/139）；은골련중건적102례（104이）중，무은골안복물탈출병례；31례（31이）상고실、고두중건적환자중，국부미견내함、이위；3례（3이）외이도수복적환자미견외이도후벽탑함。43례（48이）단순고막수보적환자술전、술후기골도차분별위23．8±3．1화11．6±8．7 dB。61례（61이）중이담지류환자술전、술후기골도차분별위39．2±24．7화19．0±12．1 dB。23례（23이）고실경화적환자술전、술후기골도차분별위31．2±12．4화19．8±11．2dB。38례（41이）만성화농성중이염반육아환자술전、술후기골도차분별위41．6±9．9화15．3±13．4dB。결론자체연골재은력중건수술중응용개치대，특별괄합우고막복잡성천공、복발성천공적수복，유리우은골련가체적고정급상고실、유돌술강급골성외이도결손수복。
Objective To study the applications and outcomes of using autogeneic cartilage in hearing recon-struction surgery in patients with chronic otitis media or cholesteatoma .Methods A total of 165 patients (173 ears) in whom autogeneic cartilage was used were analyzed retrospectively .Forty -three patients (48 ears) had simple tympanic membrane perforations ,61 patients (61 ears) had cholesteatomas including 12 retraction pockets ,23 pa-tients (23 ears) had tympanoscleroses and 38 patients (41 ears) had otitis media with granulations .The cartilage grafts were used for tympanic perforation reparing in 133 patients (139 ears) ,for ossiculoplasty in 102 patients (104 ears) ,for attic reconstruction in 31 patients (31 ears) and for canal wall reconstruction of external auditory canal in 3 patients (3 ears) .The auditory outcome (0 .5 ,1 ,2 ,and 4 kHz pure tone average hearing threshold ,the average air-bone gap) and local architecture status were followed up for 1 year after surgery .Results In 133 patients (139 ears) with tympanic perforation ,the rate of successful repair of a tympanic membrame perforation in one -stage was 97 .84% with perforation repair in 136 ears and postoperative perforation in 3 ears .In 102 patients (104 ears) of os-siculoplasty ,there was no ossicular prostheses prolapse .In 31 patients (31 ears) of attic reconstruction ,no local graft shift or collapse was found .In 3 patients (3 ears) of external auditory canal repair ,no canal wall collapse occurred . In myringoplasty group (43 patients ,48 ears) ,preoperative and postoperative air -bone gap (ABG) was 23 .8 ± 3 .1 dB and 11 .6 ± 8 .7 dB ,respectively .In cholesteatoma group (61 patients ,61 ears ) ,preoperative and postoperative ABG were 39 .2 ± 24 .7 dB and 19 .0 ± 12 .1 dB ,respectively .In tympanosclerosis group (23 patients ,23 ears) ,pre-operative and postoperative ABG were 31 .2 ± 12 .4 dB and 19 .8 ± 11 .2 dB ,respectively .In otitis media with granu-lation group (38 patients ,41 ears) ,preoperative and postoperative ABG were 41 .6 ± 9 .9 dB and 15 .3 ± 13 .4 dB ,re-spectively .Conclusion Autogeneic cartilage is very valuable in hearing reconstruction surgery ,especially in compli-cated tympanic perforation ,combination with ossiculoplasty prostheses ,or reconstruction of mastoid cavity or exter-nal call wall defect .