同种骨在乳突术腔消减技术中的临床应用

Clinical application of allogeneic bone abatement techniques in mastoid cavity surgery

目的探讨开放式乳突切除术后使用同种骨粉消减、填充乳突术腔以及外耳道后壁重建对慢性中耳乳突炎患者的近期治疗效果。方法选取2011年4月至2014年7月间来院行开放式乳突切除术的慢性中耳乳突炎患者(60例)为研究对象,术后使用同种骨粉消减、填充乳突术腔以及外耳道后壁重建,术后随访5年以上。结果 60例中有58例(占96.67%)同种骨在乳突术腔中存活,术腔完全消减,外耳道保持完整性,接近正常形态。4例(占6.67%)术后因局部同种骨小面积裸露,经耳内镜定期处理及抗感染治疗后修复愈合。2例(占3.33%)因乳突术腔大,覆盖同种骨的筋膜及皮瓣缺血坏死,造成较大范围的同种骨裸露,继发感染,同种骨坏死,予以取出,消减失败。结论同种骨可作为乳突术腔消减术中较为理想的填充材料,具有取材方便、操作简易等优点。而同种骨的裸露及修补筋膜和皮瓣的血液供应不足,出现感染坏死,是影响乳突术腔消减术成功率的不利的关键因素。术后耳内镜检查能早期发现填充物裸露,对小面积裸露予以及时修补和抗感染有显著的疗效。

Objective To explore the open resection of the mastoid bone meal using the same cut,filled mastoid cavity and canal wall reconstruction surgery recent treatment of patients with chronic otitis media.Methods Selected the patients with chronic otitis media carried open mastoidectomy（ 60 cases） for the study in the hospital from April,2011 to July,2014,after using the same cut bone meal,filling the mastoid cavity and canal wall reconstruction surgery,patients were followed for more than 5 years. Results The 60 cases,58 cases（ 96. 67%） in the same kind of survival mastoid bone cavity surgery,surgical cavity completely cut,maintained the integrity of the external auditory canal,close to the normal form. 4 cases（ 6. 67%）,the same kind of surgery because of local small area of exposed bone,ear endoscopy regularly after treatment and anti-infection treatment,healing. 2 cases（ accounting for 3. 33%） due to large mastoid surgical cavity,covering the allogeneic bone and fascia flap necrosis,resulting in a wide range of different kinds of bone exposure,secondary infection,the allogeneic bone necrosis removed,reduction failed. Conclusions The same kind as the mastoid bone reduction surgery surgical cavity ideal filling material,having drawn convenient,simple operation. The same kind of bare bones and repair fascia and flap blood supply,infection and necrosis,is a key factor in adverse surgical cavity mastoid surgery success rate abatement impact. Ear endoscopy can be found in the early detection of the filling material,which has a significant effect on the small area exposed to be repaired and anti infection in time.