完壁式上鼓室进路鼓室探查术治疗外伤性听骨链中断  

Treating traumatic ossicular chain disruption with epitympanum approach following tympanotomy

作　　者：蒋立新[1] 马玉坤[1] 罗冬[1] 杨宁[1] 李愉宗[1] 

机构地区：[1]暨南大学附属第一医院耳鼻咽喉头颈外科,广州510630

出　　处：《临床耳鼻咽喉头颈外科杂志》2008年第13期580-582,共3页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：广东省医学科研基金项目(No:A2007335);暨南大学科研启动基金项目(No:2005073)

摘　　要：目的：评估完壁式上鼓室进路鼓室探查术治疗外伤性听骨链中断的临床疗效。方法：10例（耳）颞骨骨折和耳外伤而鼓膜完整的患者,颞骨CT轴位示锤砧关节不规整,冠状位示砧镫关节不连续。虚拟耳镜示锤砧关节分离,砧镫关节脱位,听骨链中断。手术经颞线下开放上鼓室,保留完整的外耳道后上壁,充分暴露上、后鼓室和听骨链,检查并行听骨链成形术。结果：砧骨长脚骨折1耳,将砧骨改型后行锤-镫连接术;锤砧和砧镫关节脱位6耳,砧骨完全脱落3耳,行砧骨复位双关节固定术。10耳均行上鼓室进路鼓室探查术,术后语频听力平均提高25～50dB。结论：完壁式上鼓室进路鼓室探查术治疗外伤性听骨链中断疗效满意。Objective： To evaluate the therapeutic effects of epitympanum approach tympanotomy in treating traumatic ossicular chain disruption. Method：Ten patients with temporal bone fracture and trauma of ear, whose CT scan of temporal bone showed that Malleoincudal joint irregular shape in the axial view and incudostapedial joint dislocation in the coronal view, were included in this study, Virtual endoscopy showed Malleoincudal joint separation, incudostapedial joint dislocation and interruption, ossicular chain disruption in all patients. The surgical approach was opening the atticus via temporal line, remaining the intact posterior and superior wall of external acoustic meatus, exposing the atticus and posterior tympanic cavity sufficiently, and treating the lesions of ossicular chain. Result：One patient with the long process of the incus fracture, adopted the fitted incus prosthesis between the handle of the malleus and the head of the stapes. Six patients with Malleoincudal joint separation or incudostapedial joint dislocation,3 patients with incus body dislocation completely, adopted incus positioning two articulation desis. The air-conducting hearing levels had an enhancment of 25-50dB in average after surgery. Conclusion：The effect of intact canal wall epitympanum approach ossicular reposition in treating traumatic ossicular chain disruption is satisfying.

关 键 词：耳外伤 颞骨骨折 鼓室探查术 听小骨 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]