目的：探讨经典Wullstein Ⅲ型鼓室成形术在慢性化脓性中耳炎手术中的适应证及其术后听力效果。方法回顾性分析行开放式Ⅲ型鼓室成形术的患者34例（34耳），患者均有听骨链破坏而镫骨结构完整，鼓膜内陷与镫骨头或砧骨豆状突直接连接，...目的：探讨经典Wullstein Ⅲ型鼓室成形术在慢性化脓性中耳炎手术中的适应证及其术后听力效果。方法回顾性分析行开放式Ⅲ型鼓室成形术的患者34例（34耳），患者均有听骨链破坏而镫骨结构完整，鼓膜内陷与镫骨头或砧骨豆状突直接连接，根据术中是否植入钛合金部分人工听骨（partial ossicular replacement prosthesis，PORP）分为两组， Wullstein Ⅲ型鼓室成形术（Ⅲ型组）11例和植入钛合金部分人工听骨（PORP组）23例。分别比较两组术后0.5、1、2和4 kHz的平均气导听阈、平均气骨导差的变化情况。结果Ⅲ型组患者术前平均气导听阈为46.59±16.60 dB HL，术后为34.89±10.34 dB HL,气导听阈提高11.70±19.30 dB HL；PORP组术前平均气导听阈为44.23±12.31 dB HL，术后为37.08±14.36 dB HL，提高7.14±14.39 dB HL；Ⅲ型组术前平均气骨导差（air-bone gap，ABG）为23.98±13.08 dB HL，术后为16.25±6.98 dB HL，缩小7.73±14.93 dB HL；PORP型组术前平均ABG为26.58±10.27 dB HL，术后为19.40±13.28 dB HL，缩小7.17±13.63 dB HL。两组患者在气导听阈提高值及ABG缩小的差异均无显著统计学意义（P＆gt;0.05）。结论开放式鼓室成形术中，如果鼓膜内陷与镫骨头或砧骨豆状突形成连接，可以予以保留，短期随访术后听力水平与植入PORP重建听骨链的效果相当，长期效果还需随访观察。展开更多
The study was done to review postoperative hearing gain of patients with different Middle Ear Risk Index (MERI) undergoing Tympanomastoidectomies with titanium prostheses reconstruction. A Retrospective chart review w...The study was done to review postoperative hearing gain of patients with different Middle Ear Risk Index (MERI) undergoing Tympanomastoidectomies with titanium prostheses reconstruction. A Retrospective chart review was performed from September 2009 to December 2011. Of the 17 cases, 9 had moderate MERI while 8 had severe MERI. 9 patients underwent Tympanomastoidectomy with Total Ossicular Reconstruction Prostheses (TORP) and 8 with Partial Ossicular Reconstruction Prostheses (PORP). Hearing gain of 25.31 dB was achieved in cases with moderate MERI compared to 29.37 dB in severe MERI. Less than 20 dB average air-bone gap was achieved in 75% of PORP and 77.77% of TORP reconstructions. In developing countries with limited resources, decision regarding ossicular reconstruction should be made taking into account MERI, intra operative findings and type of surgery. Best results are achieved in cases of CWD with TORP and ICW with PORP.展开更多
文摘目的：探讨经典Wullstein Ⅲ型鼓室成形术在慢性化脓性中耳炎手术中的适应证及其术后听力效果。方法回顾性分析行开放式Ⅲ型鼓室成形术的患者34例（34耳），患者均有听骨链破坏而镫骨结构完整，鼓膜内陷与镫骨头或砧骨豆状突直接连接，根据术中是否植入钛合金部分人工听骨（partial ossicular replacement prosthesis，PORP）分为两组， Wullstein Ⅲ型鼓室成形术（Ⅲ型组）11例和植入钛合金部分人工听骨（PORP组）23例。分别比较两组术后0.5、1、2和4 kHz的平均气导听阈、平均气骨导差的变化情况。结果Ⅲ型组患者术前平均气导听阈为46.59±16.60 dB HL，术后为34.89±10.34 dB HL,气导听阈提高11.70±19.30 dB HL；PORP组术前平均气导听阈为44.23±12.31 dB HL，术后为37.08±14.36 dB HL，提高7.14±14.39 dB HL；Ⅲ型组术前平均气骨导差（air-bone gap，ABG）为23.98±13.08 dB HL，术后为16.25±6.98 dB HL，缩小7.73±14.93 dB HL；PORP型组术前平均ABG为26.58±10.27 dB HL，术后为19.40±13.28 dB HL，缩小7.17±13.63 dB HL。两组患者在气导听阈提高值及ABG缩小的差异均无显著统计学意义（P＆gt;0.05）。结论开放式鼓室成形术中，如果鼓膜内陷与镫骨头或砧骨豆状突形成连接，可以予以保留，短期随访术后听力水平与植入PORP重建听骨链的效果相当，长期效果还需随访观察。
文摘The study was done to review postoperative hearing gain of patients with different Middle Ear Risk Index (MERI) undergoing Tympanomastoidectomies with titanium prostheses reconstruction. A Retrospective chart review was performed from September 2009 to December 2011. Of the 17 cases, 9 had moderate MERI while 8 had severe MERI. 9 patients underwent Tympanomastoidectomy with Total Ossicular Reconstruction Prostheses (TORP) and 8 with Partial Ossicular Reconstruction Prostheses (PORP). Hearing gain of 25.31 dB was achieved in cases with moderate MERI compared to 29.37 dB in severe MERI. Less than 20 dB average air-bone gap was achieved in 75% of PORP and 77.77% of TORP reconstructions. In developing countries with limited resources, decision regarding ossicular reconstruction should be made taking into account MERI, intra operative findings and type of surgery. Best results are achieved in cases of CWD with TORP and ICW with PORP.
