Application of combined ossicular replacement prosthesis and total ossicular replacement prosthesis of type Ⅲ tympanoplasty
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摘要: 目的 探讨Ω钛质底板+全听小骨(TORP)在Ⅲ型鼓室成形术的应用，并与传统TORP人工听骨术后疗效进行比较。方法 纳入2019年1月—2020年6月于中山大学孙逸仙纪念医院耳鼻咽喉科确诊为单侧慢性化脓性中耳炎患者20例，均行耳内切口显微镜下手术治疗(鼓室探查术，病变清除+Ⅲ型鼓室成形术)，Ⅲ型鼓室成形术的听骨链重建根据放置不同类型的听小骨分为常规TORP组10例和Ω钛质底板+TORP组(组合听小骨组)10例。所有患者术前及术后1年行纯音测听，比较两组患者术前术后的平均听阈及气骨导差(ABG)。结果 所有患者听骨链重建均顺利完成，术后1个月内耳内镜检查显示术腔上皮化良好，修补鼓膜恢复良好。术后纯音测听显示，组合听小骨组与常规TORP组患者术前气导纯音听阈分别为74.13(41.50，80.50) dB和74.25(44.81，82.50) dB，差异无统计学意义(P>0.05)；术前ABG分别为55.63(21.50，61.25) dB和54.13(23.63，60.38) dB，差异无统计学意义(P>0.05)；术后ABG分别为12.00(5.75，24.56) dB和34.88(14.19，46.44) dB，差异有统计学意义(P < 0.05)。结论 组合Ω底座与全人工听小骨能增加听力重建的稳定性，提高Ⅲ型鼓室成形术的听力效果。Abstract: Objective This study investigated the application of combined ossicular replacement prosthesis(The Kurz Omega Connector+TORP) in type Ⅲ tympanoplasty, and compared the surgical effect with traditional TORP.Methods Twenty patients with unilateral chronic suppurative otitis media diagnosed in the Department of Otorhinolaryngology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 2019 to June 2020 were included in this study.All the patients were treated with intra-auricular incision with a microscopic approach(tympanic exploration, lesion clearance+type Ⅲ tympanoplasty). According to the placement of different types of ossicular replacement prosthesis in the ossicular chain reconstruction of type Ⅲ tympanoplasty, the patients were divided into two groups: the traditional TORP group(n=10) and the combined ossicular replacement prosthesis(The Kurz Omega Connector+TORP) group(n=10). All patients underwent pure tone audiometry before and 1 year after the operation, and the average hearing threshold and air-bone conduction difference(ABG) were compared between the two groups before and after the operation.Results The reconstruction of the ossicular chain was completed successfully in all patients. Endoscopic examination showed that the epithelialization of the operative cavity was good and the repair of the tympanic membrane recovered well one month after the operation. There was no significant difference in preoperative mean airway threshold between the combined ossicular replacement prosthesis and the traditional TORP group (74.13[41.50, 80.50] dB vs 74.25[44.81, 82.50] dB, P>0.05), there was no significant difference in preoperative ABG (55.63[21.50, 61.25] dB vs 54.13[23.63, 60.38] dB, P>0.05). After the operation, the ABG of the combined auriculus group was significantly lower than that of the traditional operation group (12.00[5.75, 24.56] dB vs 34.88[14.19, 46.44] dB, P < 0.05).Conclusion The combined ossicular replacement prosthesis(The Kurz Omega Connector+TORP) can increase the stability of hearing reconstruction and improve hearing in type Ⅲ tympanoplasty.
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Key words:
- otitis media /
- tympanoplasty /
- total ossicular replacement prosthesis /
- Omega connector
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表 1 常规TORP组和组合听小骨组术前及术后听力情况
dB，M(P25，P75) 组别 例数 术前气导纯音听阈 术前ABG 术后ABG 常规TORP组 10 74.25(44.81，82.50) 54.13(23.63，60.38) 34.88(14.19，46.44) 组合听小骨组 10 74.13(41.50，80.50) 55.63(21.50，61.25) 12.00(5.75，24.56) P值 >0.05 >0.05 < 0.05 
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[1] Brackmann DE, Sheehy JL, Luxford WM. TORPs and PORPs in tympanoplasty: a review of 1042 operations [J]. Otolaryngol Head Neck Surg, 1984, 92(1): 32-37. doi: 10.1177/019459988409200106
[2] Castro Sousa A, Henriques V, Rodrigues J, et al. Ossiculoplasty in chronic otitis media: Surgical results and prognostic factors of surgical success [J]. Acta Otorrinolaringol Esp(Engl Ed), 2017, 68(3): 131-137. doi: 10.1016/j.otorri.2016.06.006
[3] 中华医学会耳鼻咽喉头颈外科学分会耳科学组, 中华耳鼻咽喉头颈外科杂志编辑委员会耳科组. 中耳炎的临床分类和手术分型指南(2012)[J]. 中华耳鼻咽喉头颈外科杂志, 2013, 48(1): 5-5.
[4] Gostian AO, Kouamé JM, Bremke M, et al. Long-term Results of the Cartilage Shoe Technique to Anchor a Titanium Total Ossicular Replacement Prosthesis on the Stapes Footplate After Type Ⅲ Tympanoplasty[J]. JAMA Otolaryngol Head Neck Surg, 2016, 142(11): 1094-1099. doi: 10.1001/jamaoto.2016.2118
[5] Berenholz L, Burkey J, Lippy W. Total ossiculoplasty: advantages of two-point stabilization technique[J]. Int J Otolaryngol, 2012, 2012: 346260.
[6] Neudert M, Beleites T, Ney M, et al. Osseointegration of titanium prostheses on the stapes footplate[J]. J Assoc Res Otolaryngol, 2010, 11(2): 161-171. doi: 10.1007/s10162-009-0202-y
[7] Mantei T, Chatzimichalis M, Sim JH, et al. Ossiculoplasty with total ossicular replacement prosthesis and Omega Connector: early clinical results and functional measurements [J]. Otol Neurotol, 2011, 32(7): 1102-1107. doi: 10.1097/MAO.0b013e3182267e3b
[8] Beutner D, Luers JC, Huttenbrink KB. Cartilage 'shoe': a new technique for stabilisation of titanium total ossicular replacement prosthesis at centre of stapes footplate[J]. J Laryngol Otol, 2008, 122(7): 682-686. doi: 10.1017/S0022215108002545
[9] 鲁兆毅, 潘滔, 王宇. 鼓室成形术中保留锤骨柄及鼓膜张肌腱的术后听力重建效果分析[J]. 临床耳鼻咽喉头颈外科杂志, 2021, 35(11): 981-987. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH202111005.htm
[10] 梅雪霜, 郭红梅, 张扬, 等. 开放式鼓室成形术应用钛人工听骨近期及远期的听力疗效分析[J]. 临床耳鼻咽喉头颈外科杂志, 2016, 30(22): 1803-1805. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH201622015.htm
[11] Lin KF, Bojrab DI 2nd, Fritz CG, et al. Hearing Outcomes With a Novel Total Ossicular Replacement Prosthesis[J]. Otol Neurotol, 2021, 42(3): 447-454. doi: 10.1097/MAO.0000000000002993
[12] Faramarzi M, Jahangiri R, Roosta S. Comparison of Titanium vs. Polycel Total Ossicular Replacement Prosthesis[J]. Iran J Otorhinolaryngol, 2016, 28(85): 89-97.
[13] Berenholz LP, Burkey JM, Lippy WH. Short-and long-term results of ossicular reconstruction using partial and total plastipore prostheses[J]. Otol Neurotol, 2013, 34(5): 884-889. doi: 10.1097/MAO.0b013e31827de491
[14] Mardassi A, Deveze A, Sanjuan M, et al. Titanium ossicular chain replacement prostheses: prognostic factors and preliminary functional results [J]. Eur Ann Otorhinolaryngol Head Neck Dis, 2011, 128(2): 53-58. doi: 10.1016/j.anorl.2010.11.005
[15] Roth JA, Pandit SR, Soma M, et al. Ossicular chain reconstruction with a titanium prosthesis[J]. J Laryngol Otol, 2009, 123(10): 1082-1086. doi: 10.1017/S0022215109990375
[16] Fisch U, May J. Tympanoplasty, myringoplasty, ossiculoplasty, special applications with tympanoplasty[M]//Fisch U, May J, eds. Tympanoplasty, mastoidectomy and stapes surgery. New York: Thieme Medical Publishers Inc, 1994: 2-144.
[17] Kaplankyran H, Ceylan ME, Yyldyrym GA, et al. Audiological Results of Total Ossicular Replacement Prosthesis with Cartilage Shoe Technique[J]. Turk Arch Otorhinolaryngol, 2018, 56(2): 95-101. doi: 10.5152/tao.2018.3200
[18] Atila NE, Kilic K, Sakat MS, et al. Stabilization of total ossicular replacement prosthesis using cartilage "shoe" graft[J]. Am J Otolaryngol, 2016, 37(2): 74-77. doi: 10.1016/j.amjoto.2015.12.001
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