60例不同材料听骨链重建术的对比分析

The contrastive analysis of 60 cases of ossicular chain reconstruction using different replacement prostheses

目的回顾性分析Ⅲa型鼓室成形术采用自体和人工材料重建听骨链在听力改善、手术时间及费用的差别,为听骨链重建材料的选择提供参考。方法对接受Ⅲa型鼓室成形术使用自体砧骨、多孔聚乙烯部分听骨和钛质部分听骨进行听骨链重建的随访资料完整的60例(60耳)进行回顾性总结,其中32例为闭合式手术,28例为开放式手术。听力统计以500、1000、2000和4000Hz的平均气骨导差值计算。结果闭合式手术中自体砧骨组、多孔聚乙烯部分听骨、钛质部分听骨三组比较,术后平均气骨导差分别缩小(16.7±15.0)dB、(18.8±15.3)dB、(14.7±7.7)dB,均有明显改善,各组听力改善程度没有显著差别。开放式手术的自体砧骨组的听力改善不如人工听骨的两组听力改善。三组的手术时间没有显著差别,但是采用自体砧骨的住院费是最低的,使用钛质听骨显著增加了医疗费用。结论自体和人工听骨链重建材料都可以有效提高听力,选择自体砧骨的鼓室成形术可以减少医疗费用,但在合并开放式乳突根治术时听力改善不如使用人工听骨材料。

Objective To compare the hearing improvement, operation time and cost of surgery with autologous ossicular chain or synthetic prostheses by a retrospective analysis. Methods The study investigated 60 cases of patients underwent typeⅢa tympanoplasty with autologous incus, plastipore prosthesis, or titanium partial ossicular replacement prosthesis （PORP）, including 32 cases with wall up tympanoplasty and 28 cases with wall down tympanoplasty. The average postoperative air-bone gaps （ABG） were measured at four frequencies： 0.5, 1, 2, and 4 kHz. Results As for the wall up tympanoplasty, the postoperative ABG in autologous incus group, plastipore group and titanium group were significantly reduced by 16.7 ± 15.0 dB, 18.8 ± 15.3 dB, and 14.7 ± 7.7 dB, respectively. But there was no significant difference in hearing improvement among these groups. As for the wall down tympanoplasty, the hearing improvement in the autologous incus group was less than other groups. There was no significant difference in operation time among three groups. The medical cost in autologous incus was the lowest and the titanium group was the highest. Conclusions Both autologous and artificial ossicular reconstruction could be valuable for improving hearing. The medical cost was lowest in autologous incus group, but the hearing improvement was better in synthetic prostheses group than that in autologous incus group with the wall down tympanoplasty.