人工听骨在鼓室成形术中的应用  

Effects of ossicular reconstruction with partial ossicular replacement prosthesis in tympanoplasty

作　　者：杨仕明[1] 宇雅苹[1] 韩东一[1] 

机构地区：[1]解放军总医院耳鼻咽喉头颈外科解放军耳鼻咽喉研究所,北京100853

出　　处：《中华耳科学杂志》2007年第2期141-144,共4页Chinese Journal of Otology

摘　　要：目的评价人工听骨在鼓室成形手术中的应用效果。方法对解放军总医院耳鼻咽喉头颈外科2004年9月至2006年4月施行的中耳炎手术中,接受人工听骨部分赝复物——多孔聚乙烯听骨赝复物(Partial ossicular replacement prostheses,PORP,美国美敦力公司)植入进行听骨链重建的患者42例进行随访。对随访半年以上、资料完整的38例(38耳)进行回顾性总结,应用SPSS统计软件进行疗效分析。计算语言频率(0.5,1,2kHz)气导平均听力及气骨导差,比较不同手术方式和PORP植入方式对疗效的影响。结果38耳鼓膜修补后1个月复查均愈合良好,但术后3个月时发现2例听骨脱出(均为术中人工听骨表面未置软骨片者)。38耳术前气导听力33.75～68.5dBHL,平均为(56.82±13.64)dB;骨导听力0～47.5dB,平均为(20.217±12.099)dB;术后气导听力平均为(34.23±15.04)dB,与术前相比t=3.682,P<0.01。术前气骨导差(ABG)16.25～62.5dB,平均(36.625±12.189)dB,其中21～30dB的9耳,>30dB的24耳。术后ABG平均为(21.064±12.243)dB,与术前相比较,t=5.552,P<0.01。其中术后ABG差≤20dB的19耳,20～30dB的9耳,>30dB的8耳。术后ABG≤20dB者及ABG较术前缩小15dB者(术后听力提高有效)共28耳,总有效率为76.3%。结论PORP是一种可在听骨链重建中推广的人工听骨材料,术后取得良好的听力效果,但应注意避免术后听骨脱出。Objective To evaluate the effects of ossicular reconstruction with partial ossicular replacement prosthesis （PORP）. Methods The efficacy of ossieular reconstruction with PORP was retrospectively summed up in 42 patients in PLA General Hospital from September 2004 to April 2006. Of 42 patients, there were 38 patients followed up more than half year after surgery. The follow up audiometric measurement （the average hearing threshold at 0.5, 1.0, 2.0 kHz HL） was taken. We also compared the influence of different modus operandi and the location of the PORP on the effects. Results All the patients were followed-up for 6 - 29 months. The mean air bone gap （ABG） of 38 ears was （36.625±12,189） dB before operation, while it was elevated to （21.064±12.243） dB when followed up （P〈0.01）. Surgical treatment was found to be successful in nineteen ears （50%） and effective in nine ears （26.3%）. The total effectiveness was 76.3% （28/38ears）. It had no obvious difference between the different modus operandi and different location of PORP. Conclusion PORP could be a useful material for ossicular reconstruction and hearing improvement was obtained after operation for otitis media patients.

关 键 词：听力重建 骨气导差(ABG) PORP 鼓室成形术 

分 类 号：R764.92[医药卫生—耳鼻咽喉科] R318.18[医药卫生—临床医学]