耳内镜下微钻和三棱针镫骨底板开窗人工镫骨植入术治疗耳硬化疗效比较  

Comparison of therapeutic effects of artificial stapes implantation with fenestration of the stapes floor between micro drill and three-edged needle for the treatment of ear sclerosis

作　　者：孙祥[1] 顾丽群[1] 丁群辉 杨挈 SUN Xiang;GU Liqun;DING Qunhui;YANG Qie(Department of Otolaryngology,Suzhou EENT Hospital,Suzhou 215006,China)

机构地区：[1]江苏省苏州眼耳鼻喉科医院耳鼻喉科,苏州215006

出　　处：《中国眼耳鼻喉科杂志》2024年第2期112-115,共4页Chinese Journal of Ophthalmology and Otorhinolaryngology

摘　　要：目的比较耳内镜下使用微钻和三棱针二种工具行镫骨底板开窗人工镫骨植入术治疗耳硬化的听力效果、并发症。方法2018年3月—2023年2月本院收治的接受耳内镜下镫骨手术的耳硬化患者38例(48耳),48耳均在耳内镜下行镫骨底板开窗人工镫骨植入术,术中分别采用微钻(微钻组,26耳)和三棱针(三棱针组,22耳)进行镫骨底板开窗,植入纯钛质人工镫骨假体Piston。比较2组患者的术后听力效果,以及眩晕、面瘫、感音神经性耳聋、术中镫骨意外等并发症情况。结果48耳术后气导(AC)、骨导(BC)、气骨导差(ABG)均较术前改善,差异具有统计学意义(P值均<0.05)。其中微钻组AC改善(23.5±12.6)dB HL,BC改善(3.4±6.6)dB,ABG缩小(20.1±5.6)dB HL;三棱针组AC改善(21.4±11.8)dB HL,BC改善(3.3±6.8)dB HL,ABG缩小(18.1±4.3)dB HL,2组间差异无统计学意义(P>0.05)。术后2组均未发生面瘫和感音神经性耳聋,2组在术后眩晕和术中镫骨意外方面,差异也没有统计学意义(P值均>0.05)。结论耳内镜下人工镫骨植入术中使用微钻和三棱针行镫骨底板开窗疗效相似,二者都需要依赖精细的手术技巧和经验,微钻比三棱针更方便、更安全。Objective To compare the auditory outcomes and complications of using a microdrill and a three-edged needle in stapedotomy for stapes implantation under endoscopy in the treatment of otosclerosis.Methods Between March 2018 and February 2023,38 patients(48 ears)with otosclerosis who had undergone stapes surgery under endoscopy were admitted to our hospital.Among them,26 ears underwent stapedotomy with a microdrill(microdrill group),and 22 ears with a three-edged needle(three-edged needle group).All 48 ears received endoscopic stapedotomy and Piston implantation,using either a microdrill or a three-edged needle for the stapedotomy.The postoperative auditory outcomes,as well as complications such as dizziness,facial paralysis,sensorineural hearing loss,and intraoperative stapes accidents,were compared between the two groups.Results The postoperative mean air conduction(AC),mean bone conduction(BC),and mean airbone gap(ABG)improved significantly compared to preoperative thresholds in the 48 ears(P<0.05 for all).The microdrill group showed an average AC improvement of(23.5±12.6)dB HL,average BC improvement of(3.4±6.6)dB,and average ABG reduction of(20.1±5.6)dB HL.The three-edged needle group showed an average AC improvement of(21.4±11.8)dB HL,average BC improvement of(3.3±6.8)dB HL,and average ABG reduction of(18.1±4.3)dB HL,with no significant difference between the two groups(P>0.05).Neither group experienced facial paralysis or sensorineural hearing loss postoperatively,and there was no significant difference between the two groups in terms of postoperative dizziness and intraoperative stapes accidents(P>0.05 for both).Conclusions The effectiveness of using either a microdrill or a three-edged needle for stapedotomy in endoscopic stapes implantation surgery is similar,both requiring precise surgical skills and experience.However,the microdrill is more convenient and safer compared to the three-edged needle.

关 键 词：耳内镜 微钻 三棱针 镫骨底板开窗 人工镫骨植入术 耳硬化 

分 类 号：R764.32[医药卫生—耳鼻咽喉科]