钛质人工听骨在开放式乳突根治鼓室成形术中的应用

Effect of ossicular chain reconstruction with titanium ossicular replacement prosthesis in open mastoidectomy with tympanoplasty

目的探讨钛质人工听骨在开放式乳突根治鼓室成形术中的应用方法以及对听力的改善作用。方法51例53耳胆脂瘤中耳炎和慢性化脓性中耳炎患者行开放式乳突根治术加I期鼓室成形术,分为两组:人工听骨组28耳,术中使用Spiggle&Theis钛质人工听骨进行听骨链重建(partial ossicular replacement prosthesis,PORP21耳,total ossicular replacement prosthesis,TORP 7耳);非人工听骨组25耳,未使用人工听骨单纯行鼓室成形IIIa型术式。随访1～3年,纯音测听检测两组患者术前、术后的气导听阈及气骨导差(air-bone-gap,ABG),进行统计学分析。结果钛质人工听骨组术前ABG(36.9±11.6)dB,术后(22.4±11.8)dB,平均缩小(13.44±8.8)d B,术前术后相比差异有显著性(t=4.6 1 9 3,P<0.01),无1例出现听骨脱出;非人工听骨组术前ABG(38.5±12.3)dB,术后(31.3±14.4)dB,平均缩小(7.28±8.7)dB,术前术后相比差异无显著性(P>0.05)。钛质人工听骨组听力提高水平明显优于非人工听骨组,差异有显著性(t=2.3015,P<0.05)。结论开放式乳突根治鼓室成形术中使用人工听骨进行听骨链重建,能够提高患者听力,钛质人工听骨组织相容性好,无排斥脱出发生,是较为理想的听力重建材料。

OBJECTIVE To discuss the effects in hearing improvement of using titanium ossicular replacement prosthesis in open mastoidectomy with tympanoplasty.METHODS 51 cases（53 ears） of chronic suppurative otitis media（cholesteatoma or granulation tissue）were treated with open mastoidectomy and synchronal tympanoplasty.According to the methods of ossicular chain reconstruction,they were divided into two groups.28 ears were treated with SpiggleTheis titanium ossicular replacement prosthesis to reconstruct the ossicular chain.25 ears were treated with traditional type III tympanoplasty without prosthesis implantation.Pure tone audiometric measurement were applied on those patients during the 1-3 years follow up time.The hearing threshold of aerial conduction and air bone gap（ABG）of two groups were compared.RESULTS The mean preoperative ABG of prosthetic group was（36.9 ±11.6）dB and it was reduced to（22.4±11.8）dB after operation,which have statistical significance.There was no prosthesis prolapse.The mean preoperative ABG of non-prosthetic group was（38.5±12.3）dB and the postoperative ABG was（31.3±14.4）dB.The hearing improvement of prosthetic group was significantly better than non-prosthetic group.CONCLUSION As a biocompatible artificial material,titanium ossicular replacement prosthesis could be valuable for improving hearing in open mastoidectomy with tympanoplasty,it suggests that titanium ossicular replacement prosthesis may be perfect material of hearing reconstruction.