钛合金听骨I期听骨链重建临床疗效分析

Efficacy of ossicular chain reconstruction using titanium implants in single-stage tympanoplasty

目的探讨钛合金听骨赝复物在鼓室成形术中I期听力重建的效果。方法回顾性分析676例2008年6月至2011年1月行开放式鼓室成形伴I期听骨链重建术的病例，从中筛选具有完整中长期随访资料者106例（107耳），根据应用钛合金为全部听骨赝复物（total ossicular replacement prosthesis，TORP）或部分听骨赝复物（partial ossicular replacement prosthesis，PORP）将其分为PORP组（86耳）和TORP组（21耳），随访6至30个月，分别比较两组手术前后0．5、1、2、4kHz纯音气导平均听阈、平均气骨导差的变化及术后听力重建成功率的情况。结果PORP组术前气导平均听阈为（49．0±12．6）dBHL，术后为（31．3±7．1）dBHL，听力平均提高了17．7dBHL。TORP组术前气导平均听阈为（48．5±4．8）dBHL，术后为（29．4±4．7）dBHL，听力平均提高了19．1dBHL。PORP组术前平均气骨导差为（27．0±7．1）dB，术后为（14．5±4．6）dB，气骨导差闭合12．5dB。TORP组术前平均气骨导差为（29．1±7．2）dB，术后为（16．3±4．2）dB，术后气骨导差闭合12．9dB。两组听力重建的成功率分别为83．7％和71．4％。两组在听力提高、气骨导差闭合、听力重建成功率等方面差异均无统计学意义（P值均〉0．05）。总体听骨假体排出率为0．9％（1／107）。结论应用钛合金听骨赝复物行鼓室成形术I期听力重建，可有效提高听力，其排异率低。

Objective To explore the efficacy of total and partial ossicular chain reconstruction using titanium implants. Methods Total of 106 patients（ 107 ears） underwent ossiculoplasty using titanium fl＇om June 2008 to January 2011. Eighty-six ears had partial ossicular replacement prosthesis （PORP） and 21 ears had total ossieular replacement prosthesis （TORP）. Patient data were collected retrospectively from the database of surgical cases. Patients were assessed during 6 to 30 months postoperatively to establish middle- and long-term hearing results. Average postoperative air-conduction gain and air-bone gap （ABG） were measured at four frequencies ： 0. 5, 1,2, and 4 kHz. Results P^stoperative air-bone gap of 20 dB or less than 20 dB was obtained in 83.7% of PORP cases versus 71.4% of TORP cases. All the cases obtained significant postoperative air-conduction gains. The change in air-bone gap （ defined as the difference between the means of preoperative and postoperative ABG） was 12. 5 dB for PORP patients and 12. 9 dB for the TORP patients. There was no statistically significant difference between the TORP and PORP groups. Prosthesis exclusion was observed in one case （0. 9% ）. Conclusion Prostheses using titanium type could give good functional results and stability with low exclusion rate to patients presenting chronic otitis media.