人工耳蜗植入术中自体乳突皮质骨重建乳突腔骨质缺损

Using Autologous Mastoid Cortical Bone during Cochlear Implantation

目的探讨在成人人工耳蜗植入术中,应用自体乳突区皮质骨回放覆盖乳突切开后骨质缺损的临床效果。方法以58例行人工耳蜗植入的成人极重度感音神经性聋患者为研究对象(修复组),术中均采用切除的自体乳突区皮质骨片回放重建乳突切开后骨缺损的手术方式,术后观察患者耳后伤口痊愈情况、有无并发症;于术后1月开机时及术后3、6月检测助听听阈,并与同期未行自体乳突皮质骨重建乳突腔骨质缺损的同类患者(对照组)比较。结果修复组术后无一例出现耳后皮肤凹陷,均没有发生创面感染、急慢性中耳炎及颅内并发症,回放的皮质骨片愈合良好;术后复查所有患者耳蜗植入体无移位,术后1月开机时患者的平均助听听阈较术前提高约70dB(P<0.05),术后1、3、6月平均助听听阈与对照组差异无统计学意义(均为P>0.05),效果良好。结论在成人人工耳蜗植入手术中,应用自体乳突区皮质骨重建乳突腔皮质骨缺损能够避免耳后的凹陷,保证乳突的通气,有利于植入体的稳定性,且术后助听效果良好。

Objective To assessment the effect of autologous mastoid cortical bone to cover the mastoidetomy defect via transmastoid and posterior tympanotomy approach surgical technique during cochlear implantation in adults.Methods A total of 58 adults patients with profound sensorineural hearing loss accepted cochlear implantation from January 2010 and June 2014,which were using autologous mastoid cortical bone to cover the mastoidetomy defect via transmastoid and posterior tympanotomy approach surgical technique.By observing postoperation complication the effect of surgery was evaluated.ABR were obtained for each patients at first,third and sixth month after operation.The patients which were not using autologous mastoid cortical bone to cover the mastoidetomy defect via transmastoid and posterior tympanotomy proach surgical technique acted as control group.Results No depression was found in the postauricuhtr site.None of the patients had experienced any immediate or delayed postoperative infection complication such as wound infection,post-auricular abscess,acute otitis media,chronic otitis media,intracranial complication and necrotic of cortical bone.Autologous cortical bone cap had grew together with remnant cortical bone in all cochlear implantation patients.All implanted processor were in a good position,all patients had good results after turning on the implant.The ABR thresholds were elevated about 70 dB compare to pre-operation values（P0.05）.There was no significant difference compare to control group（P0.05）.Conclusion The technique of autologous mastoid cortical bone to cover the mastoidetomy defect in cochlear implantation surgery can prevent depression of the postauricuhtr site,remain stability of the implanted processor,and have a good aided hearingthresholds after operation.