自体骨重建听骨链的效果及其影响因素

Autogenous ossicles in ossiculoplasty: the auditory outcomes and prognostic factors

目的探讨自体骨重建听骨链在开放式鼓室成形术中的应用效果及其影响因素。方法回顾性分析2014年1月~2016年7月华中科技大学同济医学院附属荆州中心医院收治的126例行开放式鼓室成形+自体骨听骨链重建术患者的临床资料,随访6~24个月,记录术后并发症、纯音听阈及气骨导差。结果随访期间无1例自体骨脱出,未发现鼓膜内陷袋形成或胆脂瘤复发,术后干耳率达95.3%。术后气导听阈由(52.7±7.4)dB下降为(39.0±9.1)dB,气骨导差由(27.4±6.9)dB缩小为(20.8±6.2)dB。术后气骨导差<20 dB者88例,手术成功率达69.8%(88/126)。所有患者均未出现术后并发症。Logistic回归分析显示自体骨重建听骨链术后听力效果与镫骨板上结构及锤骨柄的存在与否显著相关。结论自体骨应用于开放式鼓室成形听骨链重建术中效果好。镫骨板上结构及锤骨柄的存在与否在一定程度上提示预后。

OBJECTIVE To explore the auditory outcomes and prognostic factors in ossiculoplasty using autogenous ossicles. METHODS A retrospective review was performed in 126 patients with cholesteatoma or chronic otitis media, who admitted to the Department of Otolaryngology in Jingzhou hospital affiliated to Tongji medical college from January 2014 to July 2016, and underwent canal wall-down tympanoplasty（CWDT） with ossiculoplasty using autogenous ossicles in a single stage. The postoperative complication and hearing thresholds were analyzed after 12 months＇ follow-up. RESULTS The rate of dry ear was 96.5%.We had not fou nd any extrusion of prosthesis.There was no one with postoperative retraction pocket or recur rence of cholestatoma during the follow-up. Auditory outcomes showed air conduction threshold improved from（52.7±7.4）dB to（39.0±9.1）dB after operation, while the air-bone gaps improved from（27.4±6.9）dB to（20.8±6.2）dB. Postoperative outcomes were considered successful, if the postoperative air-bone gap was 20 dB. The successful hearing was achieved in 88 patients（69.8%）. Prognostic factors were analyzed using multivariate analysis with logistic regression. And we found the presence of the stapes and the malleus handle was significantly favorable predictive factors. All the patients recovered well without severe complication. CONCLUSION Autogenous ossicles is very valuable in ossiculoplasty. The present stapes and malleus handle are important factors for the auditory outcomes in ossiculoplasty.