软骨-软骨膜复合体移植物应用于鼓室成形术

Application of composite tragus artilage-perichia graft in tympanoplasty

目的:综述软骨-软骨膜鼓室成形术的研究现状,以证明软骨-软骨膜作为鼓膜移植物其疗效明显高于单纯使用软骨膜或筋膜作为移植物的效果。资料来源:应用计算机检索M edline1985-01/2005-04期间的相关文章。检索词为“tym panic m em brane perform ation,tym panoplasty,M yringoplasty,Catilage,perichondrium”,并限定文章语种为English。同时手工或计算机检索万方数据库1979-01/2005-04期间的相关文章,限定文章语种为中文,检索词“鼓膜穿孔,鼓室成形术,鼓膜成形术,软骨软骨膜”。资料选择:选择有关软骨-软骨膜复合体作为移植物应用于鼓室成形术的中外研究原著文献72篇。资料提炼:对检索到的文章的相关信息综合加以概括,排除重复性研究,对符合标准的23篇文献进行综述。其中耳屏软骨-软骨膜鼓室成形术14篇,耳廓软骨栅软骨膜鼓室成形术3篇,肋软骨鼓室成形术2篇,耳屏软骨环-软骨膜鼓室成形术2篇,其他2篇。资料综合:90年代初期国外学者率先开始采用条栅状软骨-软骨膜技术修补鼓膜大穿孔后,现在已经在世界上得到广泛的承认及应用。软骨-软骨膜的优点是取材方便;而且弹性好,特别适用于鼓膜大穿孔、粘连性中耳炎及其他复杂情况。近年来国内采用耳屏软骨-软骨膜修制成软骨环-软骨膜作为鼓膜移植物成功应用于开放式鼓室成形术和鼓膜成形术,使听力保持稳定,鼓膜无回缩,听骨链无粘连现象,明显优于颞筋膜对照组。结论:耳屏软骨-软骨膜复合体作为移植物,应用于鼓室成形术,证明其具有减少鼓膜回缩,防止粘连,治愈率高,听力提高持久稳定等优点,特别是耳屏软骨环-软骨膜移植物遇血不卷缩、不变形,更易着床,效果更好。

OBJECTIVE： To review the researches on cartilage-periehia graft tympanoplasty, so as to prove that the effect of the application of tragus cartilage with perichondrium tympanoplasty is obviously h!gher than that after temporalis fascia tympanoplasty. DATA SOURLT, S： An online search of Medline database was undertaken by using the keywords of “tympanic membrane perforation, tympanoplasty, myringoplasty, eartilage-periehondrium”to identify the relevant articlespublished in English from January 1985 to April 2005, Meanwhile, the above keywords in Chinese were used to manually or with computer retrieve the relevant articles published between January 1979 and April 2005 we searched Wanfang database in Chinese languagee from January 1979 to April 2005, STUDY SELECTION： Seventy-two articles about the application of composite tragal cartilage-periehondia graft in tympano-plasty were selected. DATA EXTRACTION： All the selected articles and relevant information were summarized, the repetitive studies were excluded, and 23 articles accorded with the inclusive criteria were reviewed, including 14 articles on tragal cartilage-perichondria, 3 on auricular cartilage palisade-perichondria tympanoplasty, 2 on rib cartilage tympanoplasty, and 2 on tragal cartilage ring-perichondria tympanoplasty and articles another. DATA SYNTHESIS： In early 1990s, foreign exports started to use fence cartilage for repairing perforation of tympanic membrane, which now has been widely accepted. The merit of cartilage and perichondrium is that they are very easy to get and they are flexible which makes them suitable for perforation of tympanic membrane, adhesive tympanitis and other complex antrum operation. In recent years Chinese experts use tragus cartilage-perichondrium to make the annulus eartilaginous-perichondrium thus successfully use this as drum implant for middle ear plasty and drum plasty. After operation audition is stable with no drum retract and no ossicular chain eanglutination. The effect of this control group is distinctly better than that of fascia temporalis.CONCLUSION： The cartilage-perichondrium graft can be used for prevention of disease recurrence, prevent retraction pockes and progression without fear of impairing hearing. This particular application of tragal cartilage ring with perichondrium in tympanoplasty turns out that the improved operational method is of great importance to increase the quality of tympanopiasty and effective rate, owing to its reliable technique and material collection.