乳突切开术并一期听骨链重建的临床疗效分析

Effect of ossicular chain reconstruction with titanium ossicular replacement prosthesis in mastoidectomy with synchronous ossiculoplasty

目的：评估乳突切开术并一期行听骨链重建的临床疗效。方法：对2008-01～2011-06期间在我科住院行乳突切开术并一期钛人工听骨植入手术并且有完整随访资料的患者139例进行回顾分析，其中置入部分听骨赝复物（PORP）者91例，置入全听骨赝复物（TORP）者48例，随访时间为2～5年，纯音测听法（PTA）检测患者术前及术后听力，比较手术前后的气导听阈（0．5、1．0、2．0、4．0kHz四个频率气导之平均值）及气骨导差（ABG），分析钛人工听骨在同期听骨链重建术的听力重建效果。术后ABG≤20dB为听力提高有效。结果：PORP植入患者术前气导平均听阈为（53．97±11．32）dB，术后为（36．80土11．68）dB，平均降低（17．17±5．79）dB；术前ABG平均为（31．84±6．17）dB，术后为（15．13±7．22）dB，平均缩小（16．71±5．50）dB；TORP组患者术前气导平均听阈为（58．05±11．35）dB，术后为（44．53±13．15）dB，平均降低（13．52±7．81）dB；术前ABG平均为（35．67±5．73）dB，术后为（21．48±7．01）dB，平均缩小（14．18±7．53）dB；各组术前术后的差异均有统计学意义（P〈O．01）。PORP组术后ABG≤20dB者（术后听力提高有效）共68例，有效率为74．73％；TORP组术后ABG≤20dB者共26例，有效率为54．13％；总有效率为68．63％，两组之间的差异有统计学意义（P＜0．05）。结论：乳突切开术并同期钛人工听骨植入取得了良好的听力效果，PORP比TORP的听力改善效果好。

Objective：To assess hearing effect of ossicular chain reconstruction with titanium ossicular replacement prosthesis during mastoidectomy with synchronous ossiculoplasty in chronic middle ear disease. Method： Retrospective reviews were performed for 139 patients who had underwent mastoidectomy and tympanoplasty with titanium ossicular replacement prostheses at the same time between 2008 and 2011. The partial ossicular replacement prostheses （PORP） were used in 91 patients and the total ossicular replacement prostheses （TORP） were used in 48 patients respectively. All patients had follow-up for 2 to 5 years. The preoperative and postoperative mean air conduction and air-bone gaps（ABG） for the four frequencies （0.5, 1.0, 2.0 and 4.0 kHz） were evaluated. The improvement of mean air conduction and ABG over the same frequencies were measured. A postoperative ABG less than or equal to 20 dB was considered a successful operation. The hearing results of titanium PORP and TORP were compared. Result：The mean air conductions were （53.97±11.32）dB and （36.80±11.68） dB preoperatively and postoperatively in PORP group. The mean improvement in air conduction was （17. 17±5.79）dB. The mean ABG was （31.84±6.17）dB and （15.13±7.22）dB preoperatively and postoperatively in PORP group. The mean improvement in ABG was （17.71± 5, 5）dB. The difference of hearing threshold between preoperative and postoperative had statistical significance （P〈0.01）. The mean air conduction were （58.05 ± 11.35）dB and （44.53±13.15）dB preoperatively and postoperatively in TORP group. The mean improvement in air conduction was （13.52±7.81）dB. The mean ABG were （35.67 ± 5.7？,）dB and （21.48±7.01）dB preoperatively and postoperatively for TORP group. The mean improvement of hearing threshold in ABG was （14.18± 7.53）dB. The difference of hearing threshold between preoperative and postoperative had statistical significance（P〈0.01 ）. ABG less than 20 dB after operationwas happened in 68.63% of the patients （74.73% for PORP and 54.17% for TORP）. There was statistically significant difference between PORP and TORP （P〈0.05）. Conclusion： We conclude that titanium ossicular reconstruction during mastoidectomy with synchronous ossiculoplasty give stable and excellent hearing results. We obtained better results with PORP than with TORP.