锤骨-前庭桥接术在镫骨外科中的应用(附6例报告)

Malleostapedotomy in stapes surgery for otosclerosis with malleus/incus mobility disorder

目的：探讨锤骨-前庭桥接技术在治疗并发锤砧传声功能障碍的以耳硬化为主体的镫骨病变患者中的可行性、安全性及有效性。方法：对2005年3月～2007年3月78例镫骨手术中采用锤骨-前庭桥接技术的锤镫手术6例进行回顾性分析，就手术步骤、术中发现及术后眩晕加以讨论，并比较手术前后的纯音测听结果。结果：6例均存在镫骨底板固定，其中2例并发可能炎症参与的锤砧、砧镫关节变形、僵硬、固定，1例并发锤砧关节周围局灶性鼓室硬化，另2例并发锤骨前上韧带固定，最后1例为手术操作意外导致锤砧关节脱位。6例术后均无明显眩晕，0．5、1．0、2．0及4．0kHz频率范围的平均气骨导差均〈10dB，未发现4．0kHz切迹。随访3个月～2年。结论：以锤骨-前庭桥接技术为基础的锤镫手术对于不同原因所致的并发锤砧传声功能障碍的耳硬化是一种安全、有效的治疗方法。

Objective：To evaluate the feasibility, safety and effectiveness of malleostapedotomy based on malleus-oval window technique in otosclerosis with malleus/incus mobility disorder. Method：Six cases with malleostapedotomy on stapes footplate fixation accompanied by malleus/incus movements disorder from March 2005 to March 2007 were analyzed retrospectively,when totally 78 cases of conventional stapes surgeries were performed on isolated otosclerosis . The surgical procedures, intraoperative findings and postoperative vertigo as well as pure tone gain were discussed. Result：All of the 6 cases showed stapes footplate fixation. Both abnormal incudomalleular joint and incudostapedial joint were found in 2 cases. It was suspected that previous inflammation resulted in yellowish mucosa,ossicular malformation and stiffness. The third one showed local tympanosclerosis in the attic. In another 2 cases, idiopathic malleus head fixation related to the anterior and superior mallear ligament abnormal were presented while a surgical incudomalleular joint dislocation prior to the observation happened in the last one. Among these 6 cases, there was no 4.0 Hz notch and postoperative vertigo which needs a further care. Postoperative air-bone gap on 0.5 kHz, 1.0 kHz, 2.0 kHz, 4.0 kHz averaged less than 10dB. All the patients had been followed up for 3 months. Concluesion： Malleostapedotomy based on malleus-oval window technique is a safe and effective procedure available for otosclerosis with malleus/incus movement disorder from different origins.