鼓室硬化镫骨固定的手术疗效分析

The effect of surgical treatment for tympanosclerotic stapes fixation

目的分析不同手术方法治疗鼓室硬化镫骨固定的疗效。方法回顾性分析1992～2004年于我科手术且资料完整的鼓室硬化镫骨固定病例56例(62耳),按Wielinga分型Ⅲ型40耳;Ⅳ型22耳,其中镫骨撼动术15耳(Ⅲ型12耳、Ⅳ型3耳)、全人工听骨赝复物(tatolossicular replacement prosthesis,TORP)重建听骨链25耳(Ⅲ型16耳、Ⅳ型9耳)、自制Teflon小柱活塞型人工镫骨(Piston)重建听骨链22耳(Ⅲ型14耳、Ⅳ型8耳)。术后随访1～5年,分析患者言语频率(0.5、1、2kHz)平均纯音气导阈值及气骨导差,应用SPSS13.0软件包进行统计分析。结果鼓室硬化Ⅲ型、Ⅳ型患者术前言语频率平均纯音气导阈值及气骨导差差异无统计学意义(P>0.05);镫骨撼动组、TORP组、Piston组术前3组病例平均纯音气导阈值及气骨导差差异无统计学意义(P>0.05);术后1、3、5年3组病例平均纯音气导阈值及气骨导差差异有统计学意义(P<0.01);术后5年Piston组在纯音气导阈值及气骨导差方面疗效优于TORP组,差异有统计学意义(P<0.01)。结论鼓室硬化镫骨固定无论锤、砧骨固定与否,最好去除锤骨头及砧骨,予人工听骨重建听骨链,镫骨足板造孔术是安全的,而且疗效稳定。

OBJECTIVE To analyze and compare the effects of different types of surgical treatments for tympanosclerosis.METHODS Retrospective review of 56 cases（62 ears）with tympanosclerotic stapes fixation in our department from 1992 to 2004,based on Wielinga method,Type Ⅲ 40 ears and Type Ⅳ 22 ears.Mobilization of stapes in 15 ears（Type Ⅲ12 ears,Type Ⅳ 3 ears）,tatol ossicular replacement prosthesis（TORP）in 25 ears（TypeⅢ16 ears,Type Ⅳ 9 ears）,（Type Ⅲ 14 ears,Type Ⅳ 8 ears）ossicular chain reconstruction with the artificial Teflon piston in 22 ears.Patients were followed up by 1～5 years,air conduction（AC）pure tone average（PTA）and air-bone gap（ABG）of all patients in speech frequency（0.5,1,2 kHz）were analyzed,SPSS13.0 was employed for statistic analysis.RESULTS There was no significant difference in preoperative AC,ABG between type Ⅲand typeⅣ（P〉0.05）.There was no significant difference in preoperative AC,ABG among the three groups：stapes mobilization group、TORP group、Piston group（P〉0.05）.There were statistically significant difference in three groups in 1,3,5 years postoperatively（P〈0.01）.In the Piston group AC、ABG were regarded more effective than TORP group after 5 years,the difference was statistically significant（P〈0.01）.CONCLUSION For the patients with tympanosclerotic stapes fixation,whether the malleus,incus fixed or not,the best way is to remove the head of malleus and the incus and reconstruct the ossicular chain with the artificial ossicle,stapedotomy is safe and can get a stable effect.