用耳后带蒂肌筋膜骨瓣修复听骨链的疗效

Ossicular chain reconstruction with postauricular musculo-periosteal-bone flap

目的探讨用耳后带蒂肌筋膜骨瓣修复听骨链在听力重建手术中的应用。方法对47例(47耳)胆脂瘤中耳炎病人,在清除病变的同时一期行鼓室成形术,用耳后带蒂肌筋膜骨瓣修复听骨链进行听力重建。结果随访0.5-3年,全部病例均干耳,无一例胆脂瘤复发。术前临床测试平均气导51.93dB,平均骨导23.17dB;术后平均气导36.59dB,平均骨导24.23dB,术前、术后骨气导差距分别为28.76dB和12.36dB,骨气导差距改善了16.40dB,68%的病人骨气导差距缩小到20dB以内,无听力下降者。结论鼓室成形术中用耳后带蒂肌筋膜骨瓣修复听骨链行听力重建,能有效改善听力,降低胆脂瘤复发率,是一种较为实用的手术方法。

Objective To study the curative effect of ossicular chain reconstruction with postauricular musculo- periosteal-bone flap. Methods One-stage mastoidectomy and tympanoplasty with ossicular chain reconstruction using postauricular musculo-periosteal-bone flap was completed in 47 cases（47ears） of cholesteatoma. Results All cases had dry ears without recurring cholesteatoma during the follow-up period of three years. Pre-operative audiometric testing revealed a mean air conduction pure tone average （PTA） of 51.93 dBand a mean bone conduction PTA of 23.17 dB. The mean post-operative air conduction and bone conduction PTA were 36.59 dB and 24.23 dB, respectively. The mean pre- and post-operetive air-bone gaps （ABGs） were 28.76 dB and 12.36 dB, respectively, with a gain of 16.50 dB. Sixty- eight percent of patients closed their ABGs to within 20 dB, No any hearing decreased case Was found compared with that in preoperation. Conclusion One-stage mastoidectomy and tympanoplasty with ossicular chain reconstruction using postauricular musculo-periosteal-bone flap is a practical way to improve hearing and prevent cholesteatoma recurrence.