鼓室成形术中听骨链重建疗效分析  

The efficacy of ossicular reconstruction in tympanoplasty

作　　者：沈志森[1] 张宇园[1] 赵侃[1] 杨驱云[1] 沈毅[1] 关亚峰[1] 

机构地区：[1]宁波市医疗中心李惠利医院耳鼻咽喉头颈外科,315040

出　　处：《浙江医学》2009年第2期150-151,154,共3页Zhejiang Medical Journal

摘　　要：目的探讨听骨链重建在鼓室成形术中的疗效，为临床治疗中耳炎提供参考。方法选取65例（65耳）中耳炎手术患者，其中25例采用部分人工听骨赝复物（PORP）行听骨链重建，19例采用全听骨赝复物（TORP）行重建，21例采用自体颞骨行重建。术后形态学随访采用耳内镜视频检查并作摄片记录。所有患者均在术前、术后1个月、术后半年进行纯音测听，并作3种听骨链重建方式疗效比较。结果所有患者术后均无面瘫及耳鸣等并发症发生，术后1个月复查鼓膜愈合良好，术后3个月鼓膜形态与正常近似。25例PORP植入者术前ABG平均（39．52±8．22）dB，术后1个月及半年分别为（22．05±714）、（27．31±997）dB。19例TORP植入者术前ABG平均（4152±1341）dB，术后1个月及半年分别为（26±883）、（20±955）dB。21耳自体颞骨制作听小骨植入者术前ABG平均（3846±7．61）dB，术后1个月及半年分别为（1953±714）、（16．86±672）dB。3种听骨链重建方式术后1个月及半年ABG均较术前明显降低（P〈0．05或001）。结论鼓室成形术中采用PORP、TORP以及自体颞骨行听骨链重建均可以有效提高患者听力，疗效较为确切。但何种术式更好尚需进一步深入研究。Objective To investigate the efficacy of ossicular reconstruction with three types of materials in tympanoplasty. Methods The efficacy of ossicular reconstruction with PORP,TORP and artificial-oneself-hearing-bone（AOHB） was retrospectively evaluated in 65 patients with chronic otitis media from January 2003 to January 2007. All patients were followed up, and the hearing threshold was examined for the mean air bone gap （ABG） at 0.5,1.0,2.0 kHZ before operation, 1 months and 6 months after operation. Results The mean air bone gap （ABG） was 39. 52± 8. 22clB, 22.05± 7.14dB and 27.31 ± 9.97 dB in 25 PORP-ears （P〈0.01 及 P〈0.05）;41.52± 13.41dB and 26 ±8.83dB and 20 ± 9.55 dB in 19 TORP-ears （P〈0.05 and P〈0.05）;38.46 ± 7.61dB, 19.53 ± 7.14dB and 16.86± 6.72 dB in 21 AOHB-ears （P〈0.01 and P〈0.01） before operation, 1 and 6 months after operation respectively. Conclusion The ossicular reconstruction in tympanoplasty with PORP and TORP is effective in hearing improvement for patients with chronic otitis media,and the artificial-oneself- hearing- bone （AOHB） is more effective.

关 键 词：听力重建 听骨链 骨气导差 鼓室成形术 

分 类 号：R764.92[医药卫生—耳鼻咽喉科] R738.1[医药卫生—临床医学]