带切迹软骨联合砧骨嵌入听骨链重建术并腔 obliteration：一种新方法：50例听力结果分析。

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中文摘要

背景： 在慢性化脓性耳病中，传导性听力损失伴听骨链侵蚀，对耳科医生构成严重挑战。为克服这一障碍，迄今已开发出多种听骨链重建技术。对听骨链重建技术进行微小改良，并在选定病例中联合腔 obliteration，可产生可预测的良好结果。
目的： A) 研究50例Austin A组听骨缺损患者使用一片带切迹的自体耳甲软骨置于镫骨上结构上，联合砧骨嵌入和腔 obliteration 的听力结果。B) 将本研究的听力结果与其他听骨链重建方法的结果进行比较。
方法： 本研究纳入因Austin分类A组听骨缺损（M+、S+和砧骨长脚侵蚀）接受听骨链重建术且有放射学证据显示鼓室乳突区域气房骨侵蚀的患者，以及患有咽鼓管鼓室（安全）型疾病且术中发现乳突窦和窦道广泛不可逆黏膜病变的患者。研究在Darjeeling的North Bengal Medical College Hospital进行，时间为2017年11月1日至2021年10月31日。所有病例均进行了术前高分辨率颞骨计算机断层扫描、纯音测听（术前和术后）以及病变组织的组织病理学检查。所有病例均行 canal wall down 乳突切除术。采集一小片耳甲软骨（厚度：0.5 mm，直径：5 mm）。用0.6 mm金刚石钻头制作中央切迹以容纳镫骨头。将砧骨体置于带切迹软骨和锤骨头之间。采集颞肌筋膜并置于鼓环前部和乳突腔之间，覆盖新听骨链。使用两个带骨膜和软组织的皮瓣（上基和下基）进行腔 obliteration。
结果： n = 50，男性26例，女性24例。上鼓室窦病：32例，咽鼓管鼓室病：18例。术前平均气骨（AB）间隙：29.3 dB，术后平均AB间隙：19.7 dB。在74%接受带切迹软骨和砧骨嵌入听骨链重建术及腔 obliteration 的患者中，观察到术后AB间隙（平均：19.7 dB）较术前AB间隙（平均：29.3 dB）有显著改善，P < 0.001。
结论： 74%的听骨链重建患者术后AB间隙达到20 dB以内。这种使用自体软骨和听骨联合腔 obliteration 的听骨链重建技术是生理性的、生物相容性的且稳定的。

英文摘要

BACKGROUND: In chronic suppurative ear disease, conductive hearing loss with ossicular chain erosion, poses a serious challenge to the otologist. To overcome this hurdle, various ossiculoplasty techniques have been developed to date. Little modifications in the ossicular reconstruction technique, combined with cavity obliteration in selected cases, can yield predictably good results.
OBJECTIVE: A) To study the hearing outcome in 50 patients of Austin group A ossicular defect, using a piece of notched autologous conchal cartilage over the stapes suprastructure, combined with incus interposition and cavity obliteration. B) To compare the results of hearing outcomes of the present study with other methods of ossiculoplasty.
METHODS: The present study includes patients who underwent ossiculoplasty for Austin classification group A ossicular defect (M+, S+, and eroded long process of incus) with radiologic evidence of bone erosion involving air cells in the tympanomastoid region, and patients with tubotympanic (safe) disease having peroperative findings of massive irreversible mucosal disease involving the mastoid antrum and aditus. The study was done at North Bengal Medical College Hospital, Darjeeling, between November 1, 2017 and October 31, 2021. Preoperative high resolution computed tomography temporal bone, pure tone audiometry (preoperative and postoperative), and histopathological examination of the diseased tissue were done in all cases. Canal wall down mastoidectomy was done in all cases. A small piece of conchal cartilage was harvested (thickness: 0.5 mm, diameter: 5 mm). A central notch was fashioned with a 0.6 mm diamond burr to accommodate the head of the stapes. The body of the incus was placed between the notched cartilage and the malleus head. Temporalis fascia was harvested and placed between the anterior part of the annulus and the mastoid cavity, covering the neo-ossicular chain. Two flaps (superiorly based and inferiorly based) with periosteum and soft tissue were used for cavity obliteration.
RESULTS: n = 50, male 26, female 24. Atticoantral disease: 32 cases, tubotympanic disease:18 cases. Preoperative average air-bone (AB) gap: 29.3 dB, postoperative average AB gap: 19.7 dB. Significant improvement in postoperative AB gap (mean: 19.7 dB) in comparison with preoperative AB gap (mean: 29.3 dB) with a P < 0.001 was observed in 74% of patients with notched cartilage and incus interposition ossiculoplasty and cavity obliteration.
CONCLUSION: Seventy-four percent of ossiculoplasty patients achieved a postoperative AB gap within 20 dB. This technique of ossiculoplasty with autologous cartilage and ossicle with cavity obliteration is physiological, biocompatible, and stable.