钛质听小骨在中耳乳突手术中听力重建的疗效观察

Ossicular Reconstruction With Titanic Ossicular Replacement Prosthesis

目的探讨钛质人工听骨在中耳乳突手术中听骨重建的疗效。方法对50例慢性化脓性中耳炎手术并接受德国宾格钛质人工听小骨植入的患者进行随访。结果 50例鼓膜修补后1个月复查均愈合良好,术后5个月发现2例听骨脱出,其中1例合并感染。50耳术前气导听力为36.67～103.33dB,平均为(63.00±18.03)dB;骨导听力10.00～58.00dB,平均为(28.07±14.22)dB。术后气导平均听力为(43.73±17.26)dB,与术前相比,差异有统计学意义(P<0.01)。术后骨导平均听力为(27.10±16.25)dB,与术前比较无统计学意义(P>0.05)。术前气骨导差(ABG)为13.34～50.00dB,平均为(34.53±10.84)dB,术后ABG平均为(17.63±5.12)dB,二者比较,差异有统计学意义(p<0.01)。术后ABG≤20dB者及ABG较术前缩小15dB为听力提高有效共35耳,有效率为70%(35/50)。结论钛质人工听骨在听骨链重建的鼓室成形术中可以获得良好的听力效果,是一种并发症少,脱出率低,值得推广使用的人工听骨材料。

Objective To report outcomes of ossicular reconstruction with titanic ossicular replacement prosthesis. Methods Outcomes of ossicular reconstruction with titanic ossicular replacement prosthesis in 50 patients were retrospective- ly reviewed. Results Repaired tympanic membranes were well healed at 1 month followed up in all 50 patients. However, os- sicular replacement prosthesis protrusion was found in 2 cases after 5 months and complicated with infection in 1 case. Mean air conduction hearing threshold was 63.00±18.03 dB HL before tympanoplasty and 43.73±17.26 dB HL after （P〈0.01）. The mean bone conduction hearing threshold was 28.07±14.22 dB HL before operation, and 27.10±16.25 dB HL after （P〉0.05）. The mean air bone gap （ABG） was 34.5±10.84 dB HL before operation, and 17.63±5.12 dB HL at followed up （p〈0.01）oper- ation. The total effectiveness rate was70%. Conclusion Titanic ossicular replacement prosthesis can be a useful material for ossicular reconstruction with satisfactory hearing improvement in otitis media patients.