骨桥植入与Nagata耳廓再造同期手术治疗双侧外中耳畸形外耳道骨性闭锁  

Bonebridge implantation combined with simultaneous bilateral auricle reconstruction for bilateral congenital aural atresia

作　　者：王丹妮[1,2] 王冰清 王悦 任冉 陈沛维[1,2] 杨劲松 赵春丽 章庆国[3] 赵守琴 Wang Danni;Wang Bingqing;Wang Yue;Ren Ran;Chen Peiwei;Yang Jinsong;Zhao Chunli;Zhang Qingguo;Zhao Shouqin(Department of Otorhinolaryngology Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China;Beijing Institute of Otolaryngology,Beijing 100005,China;Department of Ear Reconstruction,Plastic Surgery Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100144,China)

机构地区：[1]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,100730 [2]北京市耳鼻咽喉科研究所,100005 [3]中国医学科学院,北京协和医学院,整形外科医院外耳再造中心,北京100144

出　　处：《中华耳鼻咽喉头颈外科杂志》2021年第4期340-345,共6页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：首都临床特色应用研究专项课题(Z171100001017079)。

摘　　要：目的探讨耳廓再造二期与骨桥植入同期手术治疗双侧外中耳畸形外耳道骨性闭锁的可行性及安全性。方法回顾性分析2017年2月至2020年1月北京同仁医院行双侧耳廓再造二期手术时同期行单侧骨桥植入的36例(72耳)双侧先天性外中耳畸形外耳道闭锁患者的临床资料。其中男性31例,女性5例;植入手术年龄6~12岁,平均8.1岁。所有患者均诊断为双侧先天性外中耳畸形,双侧外耳道骨性闭锁,双侧传导性聋。所有患者均采用Nagata二期法耳廓再造术,且双侧同时进行手术;于耳廓再造第二期手术时同期行单侧骨桥植入手术。分别测试患者术前及骨桥开机后纯音听阈和言语识别率,应用SPSS 17.0软件进行统计学分析。结果36例患者术后均一期愈合。患者术后骨导平均阈值较术前无明显变化[术前(8.5±5.8)dB HL,术后(8.4±5.2)dB HL],差异无统计学意义(P=0.724)。术前气导平均听阈为(64.9±7.4)dB HL,术后声场中骨桥助听听阈为(24.0±5.3)dB HL,差异有统计学意义(P<0.001)。骨桥助听下,安静环境下单音节词、双音节词及短句的言语识别率与术前相比分别提高了62.5%、63.5%及72.2%,差异有统计学意义(P值均<0.001);噪声环境下单音节词、双音节词及短句的言语识别率与术前相比分别提高了55.9%、58.9%及69.9%,差异有统计学意义(P值均<0.001)。经过平均18.3个月的随访,听力效果稳定,耳廓外形良好。远期随访发现植入体部分外露并发症1例,经皮瓣修复手术后愈合。结论采用整合手术方案,双侧外中耳畸形外耳道骨性闭锁患者可在6个月内完成双侧耳廓再造及骨桥植入,手术周期缩短,安全有效,患者听力改善及耳廓外形效果佳。Objective To investigate the feasibility and safety of auricle reconstruction combined with Bonebridge implantation for bilateral aural atresia patients.Methods A retrospective analysis was conducted for 36 cases(72 ears)who underwent Bonebridge implantation combined with bilateral auricle reconstruction from February 1,2017 to January 15,2020.All cases were bilateral congenital aural atresia and underwent Nagata auricle reconstruction for both sides simultaneously.Bonebridge implantations were performed during the second stage of auricle reconstruction.Results All 36 patients healed well and had no surgical complications when discharged.The preoperative average bone conduction threshold of the patients was(8.5±5.8)dB HL and postoperative bone conduction threshold was(8.4±5.2)dB HL.There was no significant change after the implantation(P=0.724).The preoperative average air conduction threshold of was(64.9±7.4)dB HL and postoperative air conduction threshold was(24.0±5.3)dB HL,which had a significant change after the implantation(P<0.001).The hearing threshold with Bonebridge significantly decreased by 40.9 dB HL compared with the preoperative air conduction threshold(P<0.001).The speech recognition rate of monosyllable words,disyllabic words and short sentences in quiet environment increased by 62.5%,63.5% and 72.2% respectively.The differences were statistically significant(P<0.001).The speech recognition rate of monosyllabic words,disyllabic words and short sentences in noise environment were significantly increased by 55.9%,58.9% and 69.9% respectively(P<0.001).After a follow-up of 18.3 months in average,the hearing results were stable and the aesthetic outcomes were satisfied.One patient had implant rupture and healed after revision surgery.Conclusions With an integrated surgical procedure,patients with bilateral congenital aural atresia can complete bilateral auricle reconstruction and hearing implantation within six months.This integrated surgical procedure is safe and efficient,with a stable hearing im

关 键 词：耳畸形 先天性 外科 整形 人工听觉植入 测听法 言语 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]