乳突鼓室再手术中钛听骨假体位置状态及相关因素分析

Preliminary analysis of the position and related factors of titanium ossicular prostheses during mastoid and tympanic revision surgeries

目的 回顾性研究中耳乳突再次手术病例中已植入的钛听骨假体存在状态、临床特征、影响听骨位置状态的相关因素,以期为鼓室成形术中听骨植入提供临床经验和教训。方法 总结2013—2020年行乳突鼓室成形术中植入钛听骨后6个月以上因各种原因再手术的病例,回顾分析钛听骨的位置情况、听骨位置异常的原因、处理方法。结果 在485例应用了钛听骨听力重建的鼓室成形术中,有30例再手术,其中钛听骨位置良好9例,鼓膜(TM)内陷钛听骨突出2例,TM穿孔钛听骨顶出7例,脱离TM或倾角6例,脱离镫骨患者6例。再手术原因术后感染8例,复发15例,单纯听力下降7例,术后感染均发生在术后1个月之内,而复发和单纯听力下降中位数发生时间分别为19个月(5~54个月)、30个月(4~49个月)。复发和感染中钛听骨位置良好占1/3、1/2,而单纯听力下降者钛听骨位置均异常。结论 使用钛假体的听骨成形术是一种安全有效的重建方法,再手术率较低,咽鼓管功能不良、TM内陷是钛听骨异常的主要原因,术后复发、感染为再手术的主要原因,再手术中发现前次听骨植入失败包括脱位、倒伏、突出、脱落、异物刺激反应、肉芽包裹等状态。

Objective To evaluate the position, clinical characteristics, and related factors affecting implanted titanium ossicular prostheses during middle ear revision surgeries, in order to provide a clinical experience and guidelines for ossicular chain reconstruction. Methods We recruited cases of revision surgeries performed at least 6 months after implantation of titanium ossicles during mastoid tympanoplasties, between 2013 and 2020. We retrospectively analyzed data regarding the positions of the titanium ossicle, the causes of abnormal ossicle position, and the treatment methods. Results Among the 485 cases of tympanoplasty with titanium ossicle hearing reconstruction, 30 cases were reoperated. The prosthesis position was good in nine cases, tympanic membrane(TM) atelectasis and prosthesis protrusion occurred in two cases, TM perforation and prosthesis ejection in seven cases, detachment or angular inclination of the TM in six cases, and detachment of the stapes in six cases. The indications of reoperation included postoperative infection(eight cases), recurrence(fifteen cases), and pure hearing loss(seven cases). The postoperative infections occurred within a month after surgery, but the median times of onset of recurrence and pure hearing loss were 19 months(5-54 months) and 30 months(4-49 months), respectively, following the initial surgery. The position of the ossicular prosthesis was good in 1/3 and 1/2 of the recurrence and infection cases respectively;however, the positions in isolated hearing loss cases were all abnormal. Conclusion Titanium prosthesis osteoplasty is a safe and effective reconstruction method with a low reoperation rate. Poor Eustachian tube function and TM atelectasis are the main causes of prosthesis abnormalities during reoperation. Failure of the previous prosthesis implantations could be the result of dislocation, lodging, protrusion, shedding, foreign body stimulus, and granulation wrapping during reoperation.