耳硬化症镫骨手术疗效观察

Observation of the surgical effects in otosclerosis

目的探讨耳硬化症治疗中各种术式的疗效.方法收集我院1964～2003年资料完整的部分耳硬化症病例,分别统计术耳手术前后0.25k、0.5k、1k、2kHz频率平均骨气导差,按不同术式(镫骨撼动术、镫骨足板切除足弓复位术、镫骨切除Teflon小柱植入术及镫骨活塞术)统计手术前后平均骨气导差的缩小值,t检验分析各术式间的差异,x2检验分析各术式再次手术率的差异,随访手术远期效果.结果经t检验发现,镫骨足板切除足弓复位术及镫骨活塞术听力提高明显优于镫骨撼动术及镫骨切除Teflon小柱植入术,镫骨撼动术及镫骨足板切除足弓复位术再次手术率明显高于镫骨切除Teflon小柱植入术及镫骨活塞术;镫骨活塞术术后远期效果较好.结论四种术式中镫骨足板切除足弓复位术听力提高最佳,其次为镫骨活塞术,两者之间无明显差异,明显高于镫骨撼动术及镫骨切除Teflon小柱植入术组;镫骨活塞术是治疗耳硬化症最理想术式,术后近期及远期效果较佳且再次手术率最低.

Objective To observe and explore the effect of different surgical techniques for otosclerosis .Methods Otosclerosis cases who were in hospital from 1964~2003 were collected, The differences of pre- and post-opterative air-bone gap in 0.25K,0.5K,1K,2KHz frequencies were subjected to statistical analysis by student’s t test, according to different surgical techniques(stapes mobilization, stapedectomy with stapes crus reposition, stapedectomy with Teflon restoration, stapedotomy ). The re-opertion incidence among these techniques was compared using chi-square test.The long-term results were followed up.Results The effects of stapedectomy with stapes crus reposition and stapedotomy excelled that of stapes mobilization and stapedectomy with Teflon restoration. The re-opertion incidence was markedly higher in stapes mobilization and stapedectomy with stapes crus reposition than that in stapedectomy with Teflon restoration and stapedotomy. The long-term effect was superior in the group of stapedotomy.Conclusion The hearing results were the best in stapedectomy with stapes crus reposition group and the stapedotomy group is the next best but there is no significant difference between the two groups, their hearing results are superior than that of stapes mobilization and stapedectomy with Teflon restoration groups. The stapedotomy is the best surgical procedure with good effect after short-and long-term follow-up and the incidence of re-opertion is lowest.