乳突尖部分切除加自体骨粉鼓室上壁重建在鼓室成形术中的应用  

Mastoidale partial resection and superior tympanic wall reconstruction with autogenous bone meal in tympanoplasty

作　　者：陈学华[1] 纪树芳[1] 李卡凡[1] 梅晓峰 

机构地区：[1]佛山市中医院耳鼻喉科,广东佛山528000 [2]佛山市禅城区中心医院耳鼻喉科,广东佛山528000

出　　处：《新乡医学院学报》2013年第4期273-275,278,共4页Journal of Xinxiang Medical University

基　　金：佛山市科技局医学类科技攻关项目(编号:201208051)

摘　　要：目的探讨面神经监护仪下乳突尖部分切除加自体骨粉鼓室上壁重建在鼓室成形术中的应用价值。方法 42例慢性化脓性中耳炎均行开放式鼓室成形术,其中22例行自体骨听力重建(自体骨组),20例行钛听骨重建(钛听骨组)。观察术后2组患者干耳率、干耳时间、外耳道形态、听力及并发症发生情况。结果 2组患者耳后切口均Ⅰ期愈合,术后无眩晕、面瘫、耳鸣等并发症发生;患者术后乳突腔上皮化好,无结痂,无鼓膜内陷粘连。自体听骨组和钛听骨组干耳率分别为95.5%(21/22)和95.0%(19/20),2组患者干耳率比较差异无统计学意义(P>0.05)。2组患者干耳时间比较差异无统计学意义(P>0.05);术前2组患者气导值和气骨导差值比较差异均无统计学意义(P>0.05);术后2组患者气导值和气骨导差值均显著低于术前(P<0.05);术后钛听骨组患者气导值、气骨导差值均显著低于自体听骨组(P<0.05)。结论面神经监测仪能有效识别暴露及薄骨管面神经,有利于预防术中面神经的损伤;乳突切除加自体骨粉鼓室上壁重建可获得良好的干耳效果,并可减少术后术腔结痂;钛听骨为良好的听骨链重建材料,在听力改善方面优于自体骨。Objective To explore the value of mastoidale partial resection and superior tympanic wall reconstruction with autogenous bone meal in tympanoplasty.Methods A total of 42 patients with chronic suppurative otitis media（CSOM）were treated with open tympanoplasty.Among these patients,22 patients were treated with autologous bone hearing reconstruction（autologous bone group） and 20 patients were treated with titanium auricular bone reconstruction（titanium auricular bone group）.The dry ear rate,dry ear time,external auditory canal shape,hearing and complication were observed after operation in the two groups.Results The postauricular incisions of all patients in the two groups were primary healing,and there was no postoperative complications such as vertigo,facial nerve paralysis and tinnitus and tinnitus,etc.After operation,the mastoid cavity recovered with good epithelization,and without escharosis,otopiesis or adhesion.The dry ear rate in autologous bone group and titanium auricular bone group was 95.5%（21/22）and 95.0%（19/20）,respectively;there was no significant difference in dry ear rate between the two groups（P〈0.05）.There was no significant difference in dry ear time between the two groups（P〈0.05）.Before treatment,there was no significant difference in air conduction auditory threshold and air-bone gap between the two groups（P〈0.05）.The air conduction auditory threshold and air-bone gap after treatment were significantly lower than those before treatment in the two group（P〈0.05）.After treatment,the air conduction auditory threshold and air-bone gap in titanium auricular bone group were significantly lower than those in autologous bone group（P〈0.05）.Conclusions Facial nerve monitoring can effectively identify the exposed facial nerve or thin bone canal facial nerve,and could avoid facial nerve injury during surgery.The mastoidale partial resection and superior tympanic wall reconstruction with autogenous bone meal in tympanoplasty can obtain satisfactory effect of

关 键 词：慢性中耳炎 乳突尖 骨粉 鼓室成形术 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]