钛质人工听骨在中耳胆脂瘤一期开放式鼓室成形重建中的应用  

Application of titanium ossicular prosthesis in one-stage open tympanoplasty for middle ear cholesteatoma

作　　者：王胜军 尹飞 蒋懋雨 Wang Shengjun;Yin Fei;Jiang Maoyu(Department of Otorhinolaryngology,First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital),Hefei 230001,Anhui Province,China)

机构地区：[1]中国科学技术大学附属第一医院(安徽省立医院)耳鼻咽喉-头颈外科,安徽省合肥市230001

出　　处：《中国组织工程研究》2021年第22期3505-3509,共5页Chinese Journal of Tissue Engineering Research

摘　　要：背景:随着现代耳显微外科技术发展,对于累及听骨链的病变要求手术医师选择合适的手术方法在彻底清除病灶基础上重建听骨链,而钛质听骨植入体成为听骨链重建的合适材料。目的:分析钛质人工听骨植入在中耳胆脂瘤一期开放式鼓室成形术中应用的临床效果。方法:纳入2015年8月至2018年11月中国科学技术大学附属第一医院(安徽省立医院)收治的中耳胆脂瘤患者75例,其中男40例,女35例,年龄4-76岁,均接受开放式乳突切除+鼓室成形术,术中一期植入钛质部分人工听骨61例、钛质全人工听骨14例,在鼓膜移植物与钛质人工听骨之间放置压薄的软骨-软骨膜复合体。比较75例患者术前与术后6个月的气、骨导阈值和气骨导差,评估手术后听力恢复情况。试验获得中国科学技术大学附属第一医院伦理委员会批准。结果与结论:①所有病例随访时间≥6个月,获得干耳时间4-6周;术后6,12个月时耳内镜观察显示乳突腔上皮化良好,鼓室腔含气充足,外耳道宽敞且通畅度较佳;移植鼓膜一期愈合71例,人工听骨部分脱出3例,听骨完全脱落3例;②术后6个月时,75例患者的气导听阈值低于术前(P<0.05),骨导阈值与术前比较差异无显著性意义(P>0.05);③结果表明,开放式鼓室成形术中在清理病灶的基础上采用钛质人工听骨一期重建听骨链,可以取得比较满意的听力效果,术后并发症相对较少、排异反应低,是较佳的优化治疗选择。BACKGROUND:With the development of modern otological microsurgery,for the lesions involving the ossicular chain,surgeons are required to select appropriate surgical methods to reconstruct the ossicular chain on the basis of thorough removal of the lesions.Titanium ossicular prosthesis becomes an appropriate material for reconstruction of the ossicular chain.OBJECTIVE:To analyze the clinical effect of titanium artificial ossicular prosthesis in one-stage open tympanoplasty for middle ear cholesteatoma.METHODS:This study enrolled 75 middle ear cholesteatoma patients admitted to the First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital)from August 2015 to November 2018,including 40 males and 35 females,aged 4-76 years old.All patients underwent mastoidectomy and tympanoplasty.In the first stage of the operation,partial titanium artificial ossicles were implanted in 61 cases and total titanium artificial ossicles were implanted in 14 cases.A thin cartilage perichondrium complex was placed between the tympanic membrane graft and the titanium artificial ossicle.The air,bone conduction threshold,and air bone conduction difference of 75 patients before and 6 months after the operation were compared to evaluate the hearing recovery after the operation.This study was approved by the First Affiliated Hospital of University of Science and Technology of China.RESULTS AND CONCLUSION:(1)The follow-up time of all cases was≥6 months.The outcome of dry ear was achieved about 4-6 weeks.At 6 and 12 months after the operation,the otoscope observation showed that the mastoid cavity was well epithelialized,the tympanic cavity was full of air,and the external auditory meatus was spacious and unobstructed.Totally 71 cases of tympanic membrane transplantation healed at the first stage,3 cases of artificial ossicles were partially prolapsed,and 3 cases of ossicles were completely lost.(2)At 6 months after operation,the air conduction hearing threshold of 75 patients was lower than before ope

关 键 词：材料 人工听骨 胆脂瘤 中耳 鼓室成形 听骨链重建 听小骨假体 

分 类 号：R459.9[医药卫生—治疗学] R318.08[医药卫生—临床医学]