开放式及完壁式鼓室成形一期钛人工听骨植入的疗效观察

摘要

Objective Tostudytheeffectsoftitanicartificialossiclereplacementincanalwall - downandcanalwall-up tympanoplasty for patients suffering from chronic otitis media .Methods A total of 157 cases (164 ears) un-derwent canal wall-down and canal wall -up tympanoplasty at our hospital from Feburary 2014 to Feburary 2016 were retrospectively analyzed ,in which 50 cases in canal wall down tympanoplasty with titanic ossicle replacement , 49 cases without replacement ,42 cases in canal wall -up tympanoplasty with titanic artificial ossicle replacement , and 23 cases without replacement .The average air bone gaps (ABG) before and 3 months after operations were re-corded and the average reduced ABGs were compared between sub -groups to evaluate the effects of titanic artificial ossicle replacement .Results In the canal wall-down tympanoplasty group ,the mean ABGs of 3 months after oper-ations in the replacement subgroup was 15 .72 ± 11 .18 dB ,the reduced ABGs was 17 .45 ± 5 .23 dB ,and the impro-ving rate for hearing was 71 .54％ ,statistically higher than the non -replacement subgroup(P<0 .05) .In the canal wall-up tympanoplasty group ,the mean ABGs of 3 months after operations in the replacement subgroup was 8 .13 ± 5 .37 dB ,the reduced ABGs was 26 .85 ± 11 .03 dB ,the improving rate for hearing was 75 .12％ ,statistically higher than non-replacement subgroup(P<0 .05) .Conclusion The replacement of titanic artificial ossicle in both of canal wall-down and canal wall-up tympanoplasty is helpful to improve hearing .%目的 探讨慢性化脓性中耳炎患者行开放式或完壁式鼓室成形术并一期植入钛人工听骨听力重建的效果.方法 回顾性分析2014年2月～2016年2月期间住院手术的157例(164耳)慢性化脓性中耳炎患者的临床资料,其中开放式鼓室成形并一期钛人工听骨植入50耳(开放植入组),未植入钛人工听骨49耳(开放未植入组);完壁式鼓室成形并一期钛人工听骨植入42耳(完壁植入组),未植入钛人工听骨23耳(完壁未植入组).统计并比较各组患者术前和术后3个月的纯音听阈,评估不同术式钛人工听骨植入的效果.结果 开放植入组术后平均气骨导差为15.72±11.18dB,气骨导差平均缩小17.45±5.23dB,听力重建成功率71.54％,明显优于开放未植入组(分别为22.80±14.68dB、12.80±14.68dB、22.97％)(均为P<0.05);完壁植入组术后平均气骨导差为8.13±5.37dB,气骨导差平均缩小26.85±11.03dB,听力重建成功率75.12％,明显优于完壁未植入组(分别为27.67±8.94dB、17.67±8.94dB、43.59％)(均为P<0.05).结论 慢性化脓性中耳炎患者行开放式、完壁式鼓室成形术中一期植入钛人工听骨均能有效提高听力.