乙状窦后骨桥植入在耳后皮肤扩张法耳廓再造术后患者中的临床应用

Clinical application of retrosigmoid approach for BONEBRIDGE implantation after auricle reconstruction using expanded postauricular flap

目的探讨主动选择乙状窦后骨桥植入在先天性外中耳畸形患者皮肤扩张法耳廓再造术后的安全性和可靠性。方法回顾性分析2019年9月至2023年1月在首都医科大学附属北京同仁医院行骨桥植入的43例(43耳)先天性外中耳畸形外耳道骨性闭锁或狭窄患者的临床资料。其中男性30例,女性13例;接受骨桥植入术时年龄9~36岁,中位数年龄10岁。所有患者均采用耳后皮瓣扩张法耳廓再造手术,其中扩张单皮瓣法36例,扩张双皮瓣法7例。于第三期术中或三期耳廓再造术后行乙状窦后骨桥植入手术。通过比较骨桥植入前后患者纯音听阈和言语识别率的变化,评估其听力改善效果。术后定期随访观察听力效果及并发症发生情况。应用SPSS 14.0软件进行数据统计分析。结果43例患者术后均一期愈合。术后平均骨导听阈为(8.2±6.6)dBHL,与术前[(8.1±5.7)dBHL]相比差异无统计学意义(P=0.95)。术后开机助听听阈较未助听条件下听阈明显下降[(32.8±4.6)dBHL比(60.5±5.5)dBHL],差异有统计学意义(P<0.001)。骨桥助听后,患者安静环境下单音节词、双音节词及短句的言语识别率分别提高至72%、84%和98%,与非助听相比差异有统计学意义(P值均<0.001);助听后噪声环境下单音节词、双音节词及短句的言语识别率分别提高至70%、80%和92%,与非助听相比差异有统计学意义(P值均<0.001)。术后随访4~47个月(中位数24个月),患者助听效果稳定,耳廓外形较好。1例患者在术后6个月时出现植入体线圈周围血肿,经穿刺引流及加压包扎后血肿消退,无复发。结论对于耳后皮瓣扩张法耳廓再造术后的患者,主动选择乙状窦后骨桥植入,既可减少手术瘢痕,达到外形美观的效果,又能获得术后稳定的助听效果,手术安全可靠。

Objective To explore the safety and reliability of retrosigmoid approach BONEBRIDGE implantation in patients with auricle reconstruction using skin expansion flap.Methods A retrospective analysis was conducted on 43 congenital aural atresia cases(43 ears)who underwent BONEBRIDGE implantation from September 2019 to January 2023 in Beijing Tongren Hospital.30 males and 13 females were included in this work.The implantation age was 9-36 years old(median age=10 y/o).All cases underwent auricle reconstruction surgery using the posterior ear flap expansion method,with 36 cases using the single expanded postauricular flap method and 7 cases using two-flap method.BONEBRIDGE implant surgery was performed during the third stage of auricle reconstruction or after all stages.The hearing improvements were evaluated by comparing the changes in pure tone hearing threshold and speech recognition rate of patients before and after BONEBRIDGE implantation.Routine follow-up was conducted to observe the hearing results and complications.SPSS 14.0 software was applied for data statistical analysis.Results All 43 patients healed well and had no surgical complications when discharge.The average bone conduction hearing threshold after surgery was(8.2±6.6)dBHL,and there was no statistically significant difference compared to the preoperative[(8.1±5.7)dBHL](P=0.95).After surgery,the threshold of hearing assistance with power on was significantly lower than that without hearing assistance[(32.8±4.6)dBHL vs(60.5±5.5)dBHL],and the difference was statistically significant(P<0.001).The speech recognition rate of monosyllable words,disyllabic words and short sentences in quiet environment increased to 72%,84%,and 98%respectively.The differences were statistically significant(P<0.001).The speech recognition rate of monosyllabic words,disyllabic words,and short sentences in noise environment was significantly increased by 70%,80%,and 92%respectively(P<0.001).After a follow-up of 4 to 47 months(median=24 months),the hearing results were stable and the aesthetic outcomes were satisfying.One patient had delayed hematoma around coil of the implant.After aspiration and compressed dressing for one week,hematoma was not recurrent.Conclusion For patients after auricle reconstruction using expanded postauricular flap,the preference of retrosigmoid approach is a good choice in terms of safety and reliability of operation,as well as aesthetic appearance.