CAJ | 학술논문

目的：分析鼓膜张肌腱的完整性对鼓室成形术后鼓膜形态及听力重建效果的影响，为术中鼓膜张肌腱的处理提供参考。方法回顾性分析145例（耳）慢性化脓性中耳炎患者的临床资料，按鼓膜张肌腱完整与否及植入听骨类型的不同进行分组，其中鼓膜张肌腱完整组80例[植入部分听骨赝复物（PORP）45例，全听骨赝复物（TORP）35例]，鼓膜张肌腱离断组65例（植入 PORP 34例，TORP 31例），观察并比较各组患者术后1、3个月时鼓膜形态及术后6个月时听力情况。结果术后1个月时，两组鼓膜形态无明显差别；术后3个月时，鼓膜张肌腱完整组鼓膜形态接近正常者的比例（81．25％，65/80）明显高于离断组（52．31％，34/65）。术后6个月时鼓膜张肌腱完整组（植入 PORP）0．5～4 kHz 气导平均听阈（27．48±10．02 dB HL）和气骨导差（13．57±6．36 dB）均好于鼓膜张肌腱离断组（分别为32．36±9．34 dB HL 和25．73±7．44 dB）。植入 TORP 的鼓膜张肌腱完整组0．5～4 kHz气导平均听阈（28．76±7．14 dB HL）和气骨导差（21．02±5．48 dB）也均好于鼓膜张肌腱断离组（分别为39．93±5．12 dB HL 和31．41±6．25 dB）。结论鼓膜张肌腱的完整有利于维持鼓室成形术后鼓膜的正常位置和形态，听力重建术中保留鼓膜张肌腱对术后听力恢复有明显改善作用。
목적：분석고막장기건적완정성대고실성형술후고막형태급은력중건효과적영향，위술중고막장기건적처리제공삼고。방법회고성분석145례（이）만성화농성중이염환자적림상자료，안고막장기건완정여부급식입은골류형적불동진행분조，기중고막장기건완정조80례[식입부분은골안복물（PORP）45례，전은골안복물（TORP）35례]，고막장기건리단조65례（식입 PORP 34례，TORP 31례），관찰병비교각조환자술후1、3개월시고막형태급술후6개월시은력정황。결과술후1개월시，량조고막형태무명현차별；술후3개월시，고막장기건완정조고막형태접근정상자적비례（81．25％，65/80）명현고우리단조（52．31％，34/65）。술후6개월시고막장기건완정조（식입 PORP）0．5～4 kHz 기도평균은역（27．48±10．02 dB HL）화기골도차（13．57±6．36 dB）균호우고막장기건리단조（분별위32．36±9．34 dB HL 화25．73±7．44 dB）。식입 TORP 적고막장기건완정조0．5～4 kHz기도평균은역（28．76±7．14 dB HL）화기골도차（21．02±5．48 dB）야균호우고막장기건단리조（분별위39．93±5．12 dB HL 화31．41±6．25 dB）。결론고막장기건적완정유리우유지고실성형술후고막적정상위치화형태，은력중건술중보류고막장기건대술후은력회복유명현개선작용。
Objective To study the effects of the integrity of the tensor tympani muscle on the postoperative hearing recovery and the morphology of tympanic membrane,to provide the reference for the handling of the tensor tympani muscle during the operation.Methods A total of 145 cases of chronic tympanitis were grouped by the integ-rity of the tensor tympani muscle and the implanted types of biological auditory ossicles,the clinical data were ana-lyzed retrospectively.There were 80 cases in the tensor tympani muscle intact group,including 45 cases of PORP group and 35 TORP group.The tensor tympani muscle rupture group of 65 cases consisted of 34 cases of PORP group,and 31 cases of TORP group.The postoperative recovery conditions of tympanic membrane morphology, hearing threshold Ac and air-bone gap(ABG)between the tensor tympani muscle intact group and the tensor tym-pani muscle rupture group were compared 1 month or 3 months,and 6 months after the operation.ResuIts One month after the operation,there was no significant difference in tympanic membrane morphology between the two groups.Three months after the operation,the tensor tympani muscle intact group had a higher ratio about the loca-tion and shape of tympanic membrane ,closer to the normal than the tensor tympani muscle rupture group in which the ratio in the intact group was 81.25% (65/80),while in the rupture group it was 52.31% (34/65 ).After 6 months,with the operation of PORP,the tensor tympani muscle intact group of AC value was 27.48±10.02 dB HL, and ABG value was 13.57±6.36 dB,while the rupture group of AC value was 32.36±9.34 dB HL,and ABG value was 25.73±7.44 dB.With the operation of TORP,the tensor tympani muscle intact group of AC value was 28.76± 7.14 dB HL,and ABG value was 21.02±5.48 dB,while the rupture group of AC value was 39.93 ±5.12 dB HL, and ABG value was 31.41±6.25 dB.The postoperative recovery condition of the tensor tympani muscle intact group was better than those of in the rupture group.ConcIusion The tensor tympani muscle can maintain the morphology and location of the postoperative tympanic membrane.The integrity of the tensor tympani muscle may has a positive effect on the improvement of the postoperative hearing.