乳突鼓室再手术中钛听骨假体位置状态及相关因素分析

doi:10.6040/j.issn.1673-3770.0.2021.459

摘要/Abstract

摘要： 目的回顾性研究中耳乳突再次手术病例中已植入的钛听骨假体存在状态、临床特征、影响听骨位置状态的相关因素,以期为鼓室成形术中听骨植入提供临床经验和教训。方法总结2013—2020年行乳突鼓室成形术中植入钛听骨后6个月以上因各种原因再手术的病例,回顾分析钛听骨的位置情况、听骨位置异常的原因、处理方法。结果在485例应用了钛听骨听力重建的鼓室成形术中,有30例再手术,其中钛听骨位置良好9例,鼓膜(TM)内陷钛听骨突出2例,TM穿孔钛听骨顶出7例,脱离TM或倾角6例,脱离镫骨患者6例。再手术原因术后感染8例,复发15例,单纯听力下降7例,术后感染均发生在术后1个月之内,而复发和单纯听力下降中位数发生时间分别为19个月(5~54个月)、30个月(4~49个月)。复发和感染中钛听骨位置良好占1/3、1/2,而单纯听力下降者钛听骨位置均异常。结论使用钛假体的听骨成形术是一种安全有效的重建方法,再手术率较低,咽鼓管功能不良、TM内陷是钛听骨异常的主要原因,术后复发、感染为再手术的主要原因,再手术中发现前次听骨植入失败包括脱位、倒伏、突出、脱落、异物刺激反应、肉芽包裹等状态。

关键词: 鼓室成形术, 听骨链重建, 钛听骨假体, 假体异常, 再手术

Abstract: Objective To evaluate the position, clinical characteristics, and related factors affecting implanted titanium ossicular prostheses during middle ear revision surgeries, in order to provide a clinical experience and guidelines for ossicular chain reconstruction. Methods We recruited cases of revision surgeries performed at least 6 months after implantation of titanium ossicles during mastoid tympanoplasties, between 2013 and 2020. We retrospectively analyzed data regarding the positions of the titanium ossicle, the causes of abnormal ossicle position, and the treatment methods. Results Among the 485 cases of tympanoplasty with titanium ossicle hearing reconstruction, 30 cases were reoperated. The prosthesis position was good in nine cases, tympanic membrane(TM)atelectasis and prosthesis protrusion occurred in two cases, TM perforation and prosthesis ejection in seven cases, detachment or angular inclination of the TM in six cases, and detachment of the stapes in six cases. The indications of reoperation included postoperative infection(eight cases), recurrence(fifteen cases), and pure hearing loss(seven cases). The postoperative infections occurred within a month after surgery, but the median times of onset of recurrence and pure hearing loss were 19 months(5-54 months)and 30 months(4-49 months), respectively, following the initial surgery. The position of the ossicular prosthesis was good in 1/3 and 1/2 of the recurrence and infection cases respectively; however, the positions in isolated hearing loss cases were all abnormal. Conclusion Titanium prosthesis osteoplasty is a safe and effective reconstruction method with a low reoperation rate. Poor Eustachian tube function and TM atelectasis are the main causes of prosthesis abnormalities during reoperation. Failure of the previous prosthesis implantations could be the result of dislocation, lodging, protrusion, shedding, foreign body stimulus, and granulation wrapping during reoperation.

Key words: Tympanoplasty, Ossicular chain reconstruction, Titanium ossicular prosthesis, Prosthesis dislocation, Revision surgery

中图分类号:

R775

李晓雨,赵丹珩,刘娅,刘阳. 乳突鼓室再手术中钛听骨假体位置状态及相关因素分析[J]. 山东大学耳鼻喉眼学报, 2023, 37(1): 1-5.

LI Xiaoyu, ZHAO Danheng, LIU Ya, LIU Yang. Preliminary analysis of the position and related factors of titanium ossicular prostheses during mastoid and tympanic revision surgeries[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2023, 37(1): 1-5.

参考文献

[1] Mulazimoglu S, Saxby A, Schlegel C, et al. Titanium incus interposition ossiculoplasty: audiological outcomes and extrusion rates[J]. Eur Arch Otorhinolaryngol, 2017, 274(9): 3303-3310. doi: 10.1007/s00405-017-4634-4
[2] House JW, Teufert KB. Extrusion rates and hearing results in ossicular reconstruction[J]. Otolaryngol Head Neck Surg, 2001, 125(3): 135-141. doi: 10.1067/mhn.2001.117163
[3] Folia M, Abedipour D, Naiman N, et al. Revision ossiculoplasty: anatomical and functional results[J]. Rev Laryngol Otol Rhinol(Bord), 2006, 127(3): 121-125
[4] Samy RN, Pensak ML. Revision ossiculoplasty[J]. Otolaryngol Clin North Am, 2006, 39(4): 699-712. doi: 10.1016/j.otc.2006.05.005
[5] 毛永军, 柴亮, 凌玲. 人工听骨植入术后脱出原因探讨[C] //2016年浙江省医学会耳鼻咽喉头颈外科学学术年会论文汇编.湖州, 2016: 47-48
[6] 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. doi: 10.3969/j.issn.1672-2922.2014.03.025 ZHOU Yongqing, LI Xiaoming, SHAO Yongliang, et al. Preliminary analysis of causes of titanium prosthesis extrusion after ossicular chain reconstruction[J]. Chinese Journal of Otology, 2014, 12(3): 448-451. doi: 10.3969/j.issn.1672-2922.2014.03.025
[7] Lahlou G, Sonji G, De Seta D, et al. Anatomical and functional results of ossiculoplasty using titanium prosthesis[J]. Acta Otorhinolaryngol Ital, 2018, 38(4): 377-383. doi: 10.14639/0392-100x-1700
[8] 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. doi: 10.6040/j.issn.1673-3770.0.2015.398 LIU Bin,JIANG Yuling,XIAO Xuping. Application of titanium ossicular replacement prosthesis in open mastoidectomy with tympanoplasty for ossicular chain reconstru-ction[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2016, 30(4): 80-83. doi: 10.6040/j.issn.1673-3770.0.2015.398
[9] 林伟, 朱冬超, 陈智斌. 钛人工听骨在Ⅰ期乳突切开+鼓室成形术中应用的短期疗效观察[J]. 山东大学耳鼻咽喉眼学报, 2019, 33(3): 66-70. doi: 10.6040/j.issn.1673-3770.1.2019.005 LIN Wei, ZHU Dongchao, CHEN Zhibin. Short-term effects of artificial titanium auditory ossicles in stage Ⅰ mastoidectomy and tympanoplasty [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(3): 66-70. doi: 10.6040/j.issn.1673-3770.1.2019.005
[10] Kahue CN, O'Connnell BP, Dedmon MM, et al. Short and long-term outcomes of titanium clip ossiculoplasty[J]. Otol Neurotol, 2018, 39(6): e453-e460. doi: 10.1097/MAO.0000000000001795
[11] Nguyen DQ, Lavieille JP, Schmerber S. Failure rate and revision surgery in ossiculoplasty with Kurz titanium prosthesis] [J]. Rev Laryngol Otol Rhinol(Bord), 2004, 125(3): 157-162
[12] van Stekelenburg BCA, Aarts MCJ. Determinants influencing success rates of myringoplasty in daily practice: a retrospective analysis[J]. Eur Arch Otorhinolaryngol, 2019, 276(11): 3081-3087. doi: 10.1007/s00405-019-05611-5
[13] Khan I, Jan AM, Shahzad F. Middle-ear reconstruction: a review of 150 cases[J]. J Laryngol Otol, 2002, 116(6): 435-439. doi: 10.1258/0022215021911220
[14] Jalali MM, Motasaddi M, Kouhi A, et al. Comparison of cartilage with temporalis fascia tympanoplasty: a meta-analysis of comparative studies[J]. Laryngoscope, 2017, 127(9): 2139-2148. doi: 10.1002/lary.26451
[15] Holmquist J, Renvall U, Svendsen P. Eustachian tube function and retraction of the tympanic membrane[J]. Ann Otol Rhinol Laryngol Suppl, 1980, 89(3 Pt 2): 65-66. doi: 10.1177/00034894800890s318
[16] Canali I, Petersen Schmidt Rosito L, Siliprandi B, et al. Assessment of Eustachian tube function in patients with tympanic membrane retraction and in normal subjects[J]. Braz J Otorhinolaryngol, 2017, 83(1): 50-58. doi: 10.1016/j.bjorl.2016.01.010
[17] Yazama H, Kunimoto Y, Hasegawa K, et al. Characteristics of repeated recidivism in surgical cases of cholesteatoma requiring canal wall reconstruction[J]. Ear Nose Throat J, 2021: 1455613211048575. doi: 10.1177/01455613211048575

相关文章 15

[1]	朱俊,聂儒雅综述李国义审校. 开放式乳突切开+鼓室成形术中乳突填塞材料的应用进展[J]. 山东大学耳鼻喉眼学报, 2022, 36(6): 111-116.
[2]	温立婷,李旭,高伟,胡田勇,曾宪海,查定军. 17例中耳术后迟发性面瘫的临床特征分析[J]. 山东大学耳鼻喉眼学报, 2022, 36(5): 1-5.
[3]	林伟,朱冬超,陈智斌. 钛人工听骨在I期乳突切开+鼓室成形术中应用的短期疗效观察[J]. 山东大学耳鼻喉眼学报, 2019, 33(3): 66-70.
[4]	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.
[5]	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.
[6]	陈雪生, 王威, 陶静, 尹安平. 耳后多种自体中胚层软组织及皮质骨粉填充乳突修复耳道后壁在开放式手术中的临床应用[J]. 山东大学耳鼻喉眼学报, 2014, 28(5): 18-22.
[7]	童军1，李克勇1，陈文文2，邓亚新2，蔡勋华2，单良2，杜丽君2 . 骨片重建和围手术期通气治疗根治腔的效果观察[J]. 山东大学耳鼻喉眼学报, 2013, 27(6): 31-34.
[8]	王侠，王培成，宋建京，于晓伟，张宇，王爱初，刘秀玲，王学海. 人工听骨植入前后听力学分析及相关因素研究[J]. 山东大学耳鼻喉眼学报, 2013, 27(2): 18-20.
[9]	伍红良1，唐安洲2，刘强和1. 耳软骨鼓室成形术治疗黏连性中耳炎的临床观察[J]. 山东大学耳鼻喉眼学报, 2012, 26(2): 49-50.
[10]	马喆，习国平，张社江，蔡爱军，郝艳芳，梁宝莲. 自体皮质骨外耳道重建在开放式鼓室成形术中的应用[J]. 山东大学耳鼻喉眼学报, 2012, 26(1): 60-62.
[11]	张开昌. 完整骨性外耳道鼓室成形术治疗胆脂瘤型中耳炎疗效观察[J]. 山东大学耳鼻喉眼学报, 2011, 25(2): 34-36.
[12]	林隽，沈帆，李瑞玉，叶青. 鼓室硬化类型与手术疗效(附40例临床分析)[J]. 山东大学耳鼻喉眼学报, 2010, 24(6): 10-12.
[13]	张浩亮，于锋. 带蒂颞肌筋膜隧道膜瓣在鼓室成形术中的应用[J]. 山东大学耳鼻喉眼学报, 2010, 24(5): 24-26.
[14]	陆晓红. 手术治疗鼓室硬化症46例[J]. 山东大学耳鼻喉眼学报, 2010, 24(3): 34-35.
[15]	马荣昌，李大军，李武杰. 钛网应用于开放式鼓室成形术32例[J]. 山东大学耳鼻喉眼学报, 2009, 23(6): 38-40.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed