自体颞骨听骨链重建术对慢性中耳炎患者的听力重建效果及影响因素分析  

Effect of Autologous Temporal Bone in Reconstruction of Ossicular Chain in Patients with Chronic Otitis Media

作　　者：纪洋洋[1] 徐林根[1] 姜辉[1] 

机构地区：[1]复旦大学附属金山医院耳鼻咽喉科,上海201508

出　　处：《中国临床医学》2013年第4期469-471,共3页Chinese Journal of Clinical Medicine

摘　　要：目的:探讨采用自体颞骨听骨链重建术治疗慢性中耳炎患者的疗效,并对影响听力重建的因素进行分析。方法:2008年1月—2012年12月在复旦大学附属金山医院耳鼻咽喉科行开放式乳突根治并鼓室成形术联合应用自体耳后颞骨行听骨链重建的慢性中耳炎患者92例(92耳)。对患者手术前后进行纯音听力检查,比较5个频率(0.25、0.5、1、2、4 kHz)下手术前后气骨导差(airbone gaps,ABG)的变化,并分析影响听力重建效果的因素。结果:92例患者气导听阈从术前的(53.39±14.47)dB降至术后的(46.78±17.06)dB,听力明显改善(P<0.01);手术前后骨导听阈的平均值分别为(23.29±11.93)dB及(23.08±12.36)dB,未见显著改变(P>0.05);手术前后ABG由(30.10±8.54)dB减小为(23.71±9.67)dB,P<0.01。听力重建成功56例,重建成功率为60.7%(56/92)。将重建成功的患者定义为恢复良好组(56例),其余患者定义为恢复欠佳组(36例)。比较两组后发现,导致听力重建效果欠佳的因素有年龄大、术前气骨导差大、镫骨足板固定(P<0.05)。结论:采用自体颞骨进行听骨链重建可显著改善慢性中耳炎患者的听力,影响其听力重建最重要的因素是术耳病变情况。Objective：To evaluate the efficacy of autologous temporal bone in reconstruction of ossicular chain in patients with chronic otitis media and to analyze the related factors affecting the reconstruction of ossicular chain.Methods：From January 2008 to December 2012,92 patients（92 ears）with chronic otitis media admitted to the Department of Otolaryngology in Jinshan Hospital,Fudan University have undergone canal wall down tympanoplasty with autologous temporal bone to reconstruct ossicular chain.The average pre-operative and post-operative air-bone gaps（ABG）were measured at five frequencies（0.25,0.5,1,2 and 4 kHz）.The hearing improvement and the related factors were analyzed.Results：The threshold of audibility for air-conduction decreased from（53.39±14.47）dB before opreration to（46.78±17.06）dB post-operation in92 patients,with hearing increasing significantly（P〈0.01）,whereas the threshold of audibility for bone-conduction pre-operation and post-operation were（23.29±11.93）dB and（23.08±12.36）dB,respectively,with no significant change observed（P〈0.05）.The ABG decreased from（30.10±8.54）dB before operation to（23.71±9.67）dB after operation（P〈0.01）,and ossicular chain have been successfully reconstructed with the post-operative ABG less than 20 dB in 60.7%（56/92）of the patients.Patients with ossicular chain successfully constructed were defined as well-recovered group（56 cases）,the others were defined as poorrecovered group（36 cases）.The independent risk factors for the hearing improvement were age,preoperative ABG and the fixation of the stapes footplate（P〈0.05）.Conclusions：The reconstruction of ossicular chain with autologous temporal bone could obviously improve hearing,and the most important influencing factor for improvement is the pathophysiological status of the middle ear.

关 键 词：自体颞骨 鼓室成形术 听骨链重建 慢性中耳炎 

分 类 号：R764.21[医药卫生—耳鼻咽喉科]