镫骨小窗术后砧镫关节角度与听力效果的关系探讨  

The Relationship between Incudostapedial Joint(ISJ) Angle and Hearing Outcomes after Stapedotomy

作　　者：方延青 张坤 陈兵[1] FANG Yanqing;ZHANG Kun;CHEN Bing(Eye&ENT Hospital,Fudan University,NHC Key Laboratory of Hearing Medicine,Fudan University,Shanghai,200031,China)

机构地区：[1]复旦大学附属眼耳鼻喉科医院,国家卫生健康委员会听觉医学重点实验室,上海200031

出　　处：《中华耳科学杂志》2021年第6期925-929,共5页Chinese Journal of Otology

基　　金：国家自然科学基金:Piston型镫骨假体的相关因素在中耳传音中的生物力学效应,81700925。

摘　　要：目的评估镫骨小窗术后砧镫关节角度变化对听力效果的影响,探讨镫骨手术后是否存在最佳砧镫关节角度。方法回顾性分析2017年5月至2020年3月住院手术的耳硬化症病人,均资料齐全。共纳入54例病人(女38例,男16例),其中4例行双耳手术,即58例耳(左侧27例,右侧31例)。利用多平面重组的高分辨率CT测量,获得患者术前以及术后砧镫关节角度。用相关性分析探讨砧镫骨关节角度与术后听力的关系。结果术前砧镫关节角度为:95.3±9.7°,术后为102.7±6.4°,术后砧镫关节角度比术前增大了7.4°(P=0.0001)。在250Hz至1kHz,砧镫关节角度变化与术后气导有弱的正相关性,与术后气导增益有弱的负相关性(P<0.05)。当砧镫关节角度变化小于20°时,术后成功率为72%,大于20°时,成功率为0%。术后砧镫关节角度与90°偏差大于20°时,成功率下降30%。结论镫骨小窗技术人工镫骨植入手术扩大了砧镫关节角度。与术后砧镫关节角度相比,术前术后砧镫关节角度变化可能对术后听力效果的影响更大;术后砧镫关节角度变化越大,越不利于低频气导恢复。当术后砧镫关节角度较术前的变化小于20°及术后砧镫关节角度与90°的偏差小于20°时,听力效果较好。Objective To evaluate the effect of incudostapedial joint(ISJ) angle on hearing after stapes surgery.Methods Data from patients treated for otosclerosis from May 2017 to March 2020 were retrospectively analyzed. A total of 54 patients(38 females and 16 males) were analyzed, of whom 4 underwent bilateral surgery, including 58 ears(27 left and 31 right). The ISJ angle before and after operation were measured on high-resolution CT with MPR. Relationships between the ISJ angle and postoperative hearing outcomes were accessed by correlation analysis. Results The average ISJ angle was 95.3 ± 9.7° before operation and 102.7 ± 6.4 ° postoperatively, showing an increase of 7.4°(P=0.0001)., The before and after surgery ISJ angle change showed a weak positive correlation with postoperative air conduction thresholds and a weak negative correlation with postoperative air conduction gain at 250 Hz, 500 Hz and 1 kHz(P<0.05). The success rate was 72% when the postoperative ISJ angle change was less than 20°, and 0% when the change was more than 20°. The success rate decreased by 30% when the deviation of ISJ angle from 90° was more than20°. Conclusion The ISJ angle is increased by stapedotomy and stapes-prosthesis implantation surgery. Compared with the preoperative ISJ angle, the pre-and postoperative ISJ angle change may have more influence on postoperative hearing outcomes-the more the changes of the ISJ angle, the worse recovery of low frequency air conduction thresholds.When the changes of ISJ angle is less than 20 ° and the deviation of the ISJ angle from 90° is less than 20°, hearing outcomes were better.

关 键 词：耳硬化症 镫骨手术 砧镫关节 高分辨率CT 

分 类 号：R764[医药卫生—耳鼻咽喉科]