286例三种重建材料Ⅱ型鼓室成形术听力比较分析

岳波; 王曦; 张婵娟; 乔燕; 杨润琴; 宋勇莉; 查定军; 陈阳; 邱建华

doi:10.13201/j.issn.2096-7993.2021.03.005

286例三种重建材料Ⅱ型鼓室成形术听力比较分析

- 空军军医大学第一附属医院耳鼻咽喉头颈外科(西安，710032)
基金项目:
国家自然科学基金青年项目(No：81700904)；陕西省自然科学基金(No：2018JQ8074)；海南省自然科学基金(No：817407)

详细信息

通讯作者: 陈阳, Email: chendoc@fmmu.edu.cn

中图分类号: R764.43

收稿日期: 2020-07-29

刊出日期: 2021-03-05

Comparative analysis of the hearing of three type reconstruction material in type Ⅱ tympanoplasty of 286 cases

- Department of Otolaryngology Head and Neck Surgery, First Affiliated Hospital of Air Force Military Medical University, Xi'an, 710032, China

More Information

Corresponding author: CHEN Yang, E-mail: chendoc@fmmu.edu.cn

Received Date: 29 July 2020

Publish Date: 05 March 2021

摘要

摘要: 目的探讨自体砧骨、耳廓软骨及钛质部分人工听骨(PORP)三种重建材料行Ⅱ型鼓室成形术对听力的影响。方法回顾性分析应用耳廓软骨、自体砧骨和钛质PORP重建听骨链的286例Ⅱ型鼓室成形术患者的临床资料。对各组患者手术前后0.5、1、2和4 kHz的气骨导差(ABG)进行统计和分析，并比较其术前术后的听力变化及术后并发症。结果自体砧骨组161例，术中用自体砧骨塑形后连接镫骨头和锤骨柄；PORP组95例，术中植入PORP；软骨组30例，采用耳廓软骨片直接加高镫骨。自体砧骨组0.5、1、2、4 kHz和软骨组及PORP组0.5、1、2 kHz各频率术后ABG均较术前明显缩小(P < 0.05)，软骨组和PORP组4 kHz手术前后ABG无明显差异(P>0.05)。自体砧骨组术后有1例患者出现极重度感音神经性聋，1例骨导高频下降，其余患者骨导听阈较术前无明显变化。自体砧骨组有3例术后出现暂时性面瘫，自体砧骨组和软骨组术后各有1例暂时性眩晕，术后自体砧骨组、软骨组及PORP组分别有5例、3例及11例再穿孔，PORP组有1例听骨脱出。结论 Ⅱ型鼓室成形术可以选择自体砧骨、耳廓软骨及PORP作为重建材料，其听力重建效果相仿。自体砧骨、耳廓软骨作为重建材料经济性更佳，PORP植入技术要求最低、适用面最广，但仍有一定的听骨脱出的风险。
- 鼓室成形术 /
- 重建材料 /
- 听力
Abstract: Objective To compare the effect on hearing of different reconstruction material in type Ⅱ tympanoplasty. Methods Retrospectively analysis of 286 patients who accepted type Ⅱ tympanoplasty. The air-bone gap of 0.5, 1, 2, 4 kHz was analyzed before and after operation. We compared the hearing change and the complications between each group. Results In incus group, the manubrium mallei and the head of stapes were connected with shaped incus, PORP group were implanted with PORP during operation, and cartilage group used auricular cartilage to cover the head of stapes. There was no significant difference in 4 kHz air-bone gap(ABG) between the cartilage group and PORP group either before or after the operation (P>0.05). Air-bone gap of 0.5, 1, 2, 4 kHz of the incus group, and the 0.5, 1, 2 kHz of the cartilage and PORP group were significantly reducedafter the operation(P < 0.05). One patient got severe sensorineural hearing loss in incus group after the operation. The high frequency of bone conduction decreased in 1 patient(2, 4 kHz).In the incus group, 3 patients had temporary facial paralysis after operation. Incus and cartilage group each have 1 patient with dizziness after the operation. Incus, cartilage and PORP group had 5, 3 and 11 patients with perforation again respectively. There was extrusion occurred in 1 patient of PORP group. Conclusion Self incus, cartilage and PORP can be used in typeⅡ tympanoplasty, the effect of hearing reconstruction is similar. The first two are more economical, PORP implantation has the lowest technical difficulty and the most widely application, but there is a certain risk of extrusion.
- tympanoplasty /
- reconstruction materials /
- hearing

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图 1 自体砧骨组Ⅱ型鼓室成形术前术后ABG比较

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图 2 PORP组Ⅱ型鼓室成形术前术后ABG比较

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图 3 软骨组Ⅱ型鼓室成形术前术后ABG比较

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图 4 3种材料Ⅱ型鼓室成形术后ABG比较

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图 5 3组Ⅱ型鼓室成形术的手术时间比较

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表 1 286例患者临床资料比较

组别	例数	性别/例(%)		侧别/例(%)		年龄/岁	病程/年
组别	例数	男	女	左	右	年龄/岁	病程/年
PORP组	95	31(32.63)	64(67.37)	54(56.84)	41(43.16)	39.03±14.21	21.59±13.48
软骨组	30	8(26.67)	22(73.33)	13(43.33)	17(56.67)	42.17±13.21	18.86±15.14
自体砧骨组	161	44(27.33)	117(72.67)	89(55.28)	72(44.72)	39.77±14.19	20.88±14.86

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