纳米生物陶瓷在听小骨重建及乳突修复中的应用

Application of hydroxyapatite in micro-otosurgery:experiment with guinea pigs and clinical application

目的 探讨以纳米羟基磷灰石（HA）为材料的生物陶瓷听骨假体替代中耳听骨缺损的生物相容性、手术应用及临床效果。方法 健康、白色豚鼠12只（24耳），双侧听泡置入HA块，1-4个月后每月3只断头取双侧听泡（6个），行植人物表面接触缘大体形态学及扫描电镜检查。临床应用HA行中耳手术47例，包括听骨链重建、外耳道后壁重建、乳突填充。结果 12只豚鼠23只听泡光镜及扫描电镜检查，植人物界面形态良好，结构完整，边界清晰。临床鼓室成形术病例术后愈合良好，听力较术前提高16dBHL；耳道后壁重建1例外耳道后壁感染，乳突填充病例术后外耳道宽敞，上皮愈合良好，愈合时间明显缩短。结论 HA作为听骨替代物及重建材料，以其优良的理化生物相容性在听骨链重建术、乳突填充外耳道后壁重建中均为合适的应用选择，所设计的HA听骨假体在材料选择及外形尺寸方面均适合于临床应用。

Objective To investigate the feasibility of hydroxyapatite （HA） middle ear prostheses in otosurgery. Methods In the animal experiment HA prostheses were put in the bilateral bullae of the ears of 12 healthy white guinea pigs （totally 24 ears）. Three guinea pigs were killed every month 1～4 months later. Morphological examination and electron microscopy were conducted to observe grafts. In the clinical experiment HA prostheses was used in ossiculoplasty in 31 cases, reconstruction of posterior wall of external auditory canal in 5 cases, and mastoid obliteration in 11 cases. Results The HA prostheses taken out from 23 ears of the guinea pigs were with normal and complete structure, and clear margin in gross anatomy and microscopically. Only one ear suffered infection. Follow-up or the patients for 1～ 4 years showed excellent healing of the operated parts and an improvement of hearing threshold by about 16 dBHL. Conclusion Hydroxyapatite With excellent physical and chemical properties and biological tolerance HA is a good material in ossiculoplasty, canaloplasty, mastoid obliteration, and other otological operations.