蝶形软骨、耳屏软骨及颞肌筋膜在鼓膜成形术中的应用

Application of butterfly cartilage, tragus cartilage and temporalis fascia in myringoplasty

目的 对比蝶形软骨膜、耳屏软骨膜及颞肌筋膜在干性穿孔鼓膜成形术中的应用,为鼓室成形术选择最佳自体移植材料提供临床依据。方法 根据使用修复材料的不同将鼓室成形术114例患者分为3组,分别为蝶形软骨膜组、耳屏软骨膜组及颞肌筋膜组,每组38例。观察3组患者手术时间、术中出血量、愈合率、平均纯音听阈(PTA)及平均气骨导差(ABG)。结果 3组手术时间、术中出血量差异无统计学意义(P>0.05)。蝶形软骨膜组与耳屏软骨膜组的骨膜愈合率高于颞肌筋膜组(P<0.05)。与术前比较,术后3组PTA、ABG均明显降低(P<0.01);与颞肌筋膜组比较,蝶形软骨膜组和耳屏软骨膜组的PTA、ABG均明显降低(P<0.05或0.01),且以蝶形软骨膜组更为显著(P<0.05或0.01)。蝶形软骨膜组的PTA明显低于耳屏软骨膜组(P<0.01)。结论 采用蝶形软骨技术能明显提高鼓膜成形术的愈合率,改善听力,且操作简便,值得临床推广。

Objective To compare the application of butterfly cartilage, tragus cartilage and temporalis fascia in dry perforated myringoplasty to provide clinical basis for the selection of the optimal autograft material for myringoplasty.Methods According to the different repairing materials, 114 cases of myringoplasty were divided into the Butterfly Cartilage Group, Tragus Cartilage Group and Temporalis Fascia Group, 38 cases in each group. The three groups were compared in the operative time, intraoperative blood loss, healing rate, PTA and ABG. Results There were no significant differences in the operation time and intraoperative blood loss among the three groups(P>0.05). The Butterfly Cartilage Group and Tragus Cartilage Group had the periosteal healing rate higher than the Temporalis Fascia Group(P<0.05). The PTA and ABG in the three groups were significantly lower than those in the three groups before operation(P<0.01), but the PTA and ABG in the Butterfly Cartilage Group and Tragus Cartilage Group was significantly lower than those of the Temporalis Fascia Group(P<0.01or 0.05), and the Butterfly Cartilage Group showed a more significant change(P<0.01 or 0.05). The PTA of the Butterfly Cartilage Group was significantly lower than that of the Tragus Cartilage Group(P<0.01). Conclusion The adoption of butterfly cartilage can significantly increase the healing rate of myringoplasty and improve hearing. The operation is simple and worth clinical promotion.