钛质人工听小骨在开放式鼓室成形术中的疗效观察与应用体会

doi:10.6040/j.issn.1673-3770.0.2015.398

摘要/Abstract

摘要： 目的探讨Ⅰ期钛质人工听小骨听力重建在慢性中耳炎和中耳胆脂瘤患者中的临床疗效及应用体会。方法回顾性分析行开放式鼓室成形术并接受Ⅰ期钛质人工听小骨听力重建的慢性中耳炎或中耳胆脂瘤患者65例临床资料,比较术前及术后1、3、6个月听力情况和气骨导差(ABG)。结果术后第1、3、6个月,纯音气导听阈均值(PTA)较术前降低,差异有统计学意义(P<0.05);术后6个月ABG均值较术前降低,差异具有统计学意义(P<0.05);术后ABG≤20 dB者达39耳(P<0.05)。结论开放式鼓室成形术加Ⅰ期钛质人工听小骨行听骨链重建治疗慢性中耳炎和中耳胆脂瘤能够有效提高患者的听力水平;选择适当的手术适应证、良好的手术技巧及围手术期处理是取得成功的保证。

关键词: 听小骨假体, 中耳炎, 胆脂瘤, 鼓室成形术

Abstract: Objective To explore the effects of using titanium ossicular replacement prosthesis in open mastoidectomy with ympanoplasty. Method From January 2013 to March 2015, 65 cases with chronic suppurative otitis media and middle ear cholesteatoma were treated with open mastoidectomy and tympanoplasty. Ossicular chains were reconstructed by partial ossicular replacement prosthesis(PORP)or total ossicular replacement prosthesis(TORP). The clinical data of these cases were retrospectively analyzed. The hearing threshold of air conduction and air bone gap(ABG)were compared before and 1,3,6 months after surgery. Results After 6 months of operation, the pure tone average(PTA)and averaged ABG of patients with chronic suppurative otitis media or middle ear cholesteatoma were dropped compared with those before surgery, with significant difference(P<0.05). There were 39 ears with an ABG lower than 20 dB after operation. Conclusion The effects of using titanium ossicular replacement prosthesis in open mastoidectomy with tmpanoplasty is satisfied for patients with chronic suppurative otitis media or middle ear cholesteatoma. The surgical indication and technique, as well as perioperative management, should be considered to ensure the success of operation.

Key words: Otitis Media, Tympanoplasty, Titanium ossicula prosthesis, Cholesteatoma

中图分类号:

R765.2

刘斌,江育玲,肖旭平. 钛质人工听小骨在开放式鼓室成形术中的疗效观察与应用体会[J]. 山东大学耳鼻喉眼学报, 2016, 30(4): 80-83.

LIU Bin, JIANG Yuling, XIAO Xuping. Application of titanium ossicular replacement prosthesis in open mastoidectomy with tympanoplasty for ossicular chain reconstruction.[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2016, 30(4): 80-83.

参考文献

[1] 中华医学会耳鼻咽喉头颈外科学分会耳科学组, 中华耳鼻咽喉头颈外科杂志编辑委员会耳科组. 中耳炎临床分类和手术分型指南(2012)[J]. 中华耳鼻咽喉头颈外科杂志, 2013, 48(1): 5.
[2] 孔维佳. 耳鼻咽喉头颈外科学[M]. 北京:人民卫生出版社, 2012: 781-782.
[3] 杨仕明, 宇雅苹, 韩东一. 人工听骨在鼓室成形术中的应用[J]. 中华耳科学杂志,2007, 5(2):141-144. YANG Shiming YU Yaping, HAN Dongyi. Effects of ossicular reconstruction with partial ossicular replacement prosthesis in tympanoplasty[J]. Chin J Otol, 2007, 5(2):141-144.
[4] 罗五根, 张剑, 曾亮, 等. 钛人工听骨在Ⅰ期鼓室成形术中的临床疗效分析[J]. 中华耳科学杂志, 2012, 10(1):31-34. LUO Wugen, ZHANG Jian, ZENG Liang, et al. Outcomes of using titanium ossicular prosthesis in one stage tympanoplasty[J]. Chin J Otol, 2012, 10(1):31-34.
[5] Wang X, Song J, Wang H. Results of tympanoplasty with titanium implants[J]. Otolaryngol Head Neck Surg, 1999, 121(5):606-609.
[6] Krueger W W, Feghali J G, Shelton C, et al. Preliminary ossiculoplasty results using the Kurz titanium prostheses[J]. Otol Neurotol, 2002, 23(6):836-839.
[7] Ho S Y, Battista R A, Wiet R J. Early results with titanium ossicular implants[J]. Otol Neurotol, 2003, 24(2):149-152.
[8] Martin A D, Hardner S G. Ossicular reconstruction with titanium prosthesis[J]. Laryngoscope, 2004, 114(1): 61-64.
[9] Vassbotn F S, Møller P, Silvola J. Short-term results using Kurz titanium ossicular implants[J]. Eur Arch Otorhinolaryngol, 2007, 264(1):21-25.
[10] 刘林, 秦兆冰, 李素娟, 等. 鼓膜张肌腱对鼓室成形术后听力重建效果的影响[J]. 听力学及言语疾病杂志, 2014, 22(6):573-576. LIU Lin, QIN Zhaobing, LI Sujuan, et al. The effects of tensor tympani muscie on the hearing reconstruction outcome[J]. J Audiol Speech Pathol, 2014, 22(6):573-576.
[11] 孙建军. 听骨链修复与功能重建的理论与实践[J]. 临床耳鼻咽喉头颈外科杂志, 2014, 28(4):215-218. SUN Jianjun. Theory and practice on reconstruction of the ossicular chain with improving of acoustic functional[J]. J Clin Otorhinolaryngol Head Neck Surg, 2014, 28(4):215-218.
[12] 迟放鲁. 钛合金人工听骨关节的临床应用[J]. 中国医学文摘:耳鼻咽喉科学, 2009, 24(4):208-210. CHI Fanglu.The clinical application of titanium alloy artificial bone joint[J]. Chin Med Abstracts Otorhinolarynol, 2009, 24(4):208-210.
[13] 曾立刚, 李江平. 人工听骨链重建材料的生物相容性及其应用特点[J]. 中国组织工程研究与临床康复, 2007, 11(48):9789-9792. ZENG Ligang, LI Jiangping. Biocompatibility and application of artificial ossicular chain reconstruction materials[J]. J Clin Rehabilitative Tissue Engineering Research, 2007, 11(48):9789-9792.
[14] 肖大江, 袁渊. 人工钛质听骨重建听骨链的疗效观察[J]. 山东医大基础医学院学报, 2001, 15(6):326-327. XIAO Dajiang, YUAN Yuan. Reconstruction of ossicular chain with titanium auditory ossicles[J]. J Preclin Med Coll Shandong Med Univ, 2001, 15(6):326-327.
[15] 周永青, 李晓明, 邵永良, 等. 钛人工听骨植入术后假体脱出原因分析[J].中华耳科学杂志, 2014, 12(3):448-451. ZHOU Yongqing, LI Xiaoming, SHAO Yongliang, et al. Preliminary analysis of causes of titanium prosthesis extrusion after ossicular chain reconstruction[J]. Chin J Otol, 2014, 12(3):448-451.

相关文章 15

[1]	谢日林,张志平. 布地奈德体位滴鼻治疗伴腺样体肥大的小儿分泌性中耳炎31例[J]. 山东大学耳鼻喉眼学报, 2018, 32(1): 65-67.
[2]	张孟璐,李永团. 继发性胆脂瘤中CCL27的定位及检测[J]. 山东大学耳鼻喉眼学报, 2017, 31(6): 46-48.
[3]	马钊恩, 翟锦明, 廖礼兵, 杨震. 咽鼓管球囊扩张术治疗慢性分泌性中耳炎的短期疗效观察[J]. 山东大学耳鼻喉眼学报, 2017, 31(5): 54-56.
[4]	王登元,陈智斌,陈若希,赵晓埝,刘丞. 外耳道胆脂瘤的临床特征及疗效评估[J]. 山东大学耳鼻喉眼学报, 2017, 31(5): 62-66.
[5]	吴允刚,张辉,刘黎明,庞太忠,李晓瑜. 鼓膜激光打孔治疗分泌性中耳炎20例[J]. 山东大学耳鼻喉眼学报, 2017, 31(1): 85-87.
[6]	杜丽君,童军,陈文文,邓亚新,蔡勋华,单良. 单侧听力耳中耳炎手术经验再探讨[J]. 山东大学耳鼻喉眼学报, 2016, 30(6): 8-10.
[7]	孙娜综述,陈晓平审校. 咽喉反流与耳鼻咽喉科疾病[J]. 山东大学耳鼻喉眼学报, 2016, 30(6): 85-89.
[8]	朱琳,张德军,管国芳,郭颖媛. 显微镜联合耳内镜手术治疗岩尖巨大胆脂瘤一例[J]. 山东大学耳鼻喉眼学报, 2016, 30(6): 101-103.
[9]	李兆生, 洪斌, 黄前进, 蒲伟民, 许振跃. 耳源性小脑脓肿2例并文献复习[J]. 山东大学耳鼻喉眼学报, 2015, 29(5): 32-37.
[10]	梁冬泳, 何中扬, 李趣, 邹秀园, 黄岳, 王菊新, 卓勇智. 两种途径鼓室注入地塞米松治疗分泌性中耳炎的临床研究[J]. 山东大学耳鼻喉眼学报, 2015, 29(5): 29-31.
[11]	孙昌志, 刘文龙, 李琰, 罗仁忠. 双耳感音神经性聋患儿合并分泌性中耳炎的临床诊治[J]. 山东大学耳鼻喉眼学报, 2015, 29(4): 11-14.
[12]	刘谦虚, 张志钢, 赵晓明, 李海鸥. 中青年与老年慢性化脓性中耳炎及中耳胆脂瘤患者听力学特点及区别[J]. 山东大学耳鼻喉眼学报, 2015, 29(3): 24-28.
[13]	李慎玲, 张孝田, 姜晓丹, 黄天桥, 郭鸽, 梁大鹏. 53例慢性化脓性中耳炎患者分泌物细菌培养及药敏学分析[J]. 山东大学耳鼻喉眼学报, 2015, 29(3): 31-34.
[14]	郭艳红, 潘焱, 王济生. 中耳胆脂瘤的高分辨率CT盾板表现[J]. 山东大学耳鼻喉眼学报, 2015, 29(2): 17-19.
[15]	陈泽, 钟兆棠, 梁敏志. 前壁外耳道-鼓膜瓣应用于开放式鼓室成形术31例[J]. 山东大学耳鼻喉眼学报, 2014, 28(6): 11-15.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed