Article record

术前气骨导差可预测耳硬化症中需微钻开窗的厚镫骨足板

Preoperative air-bone gap predicts thick stapes footplate requiring microdrill fenestration in otosclerosis.

临床研究耳科IF 1.8Q2

文献信息

PMID	42805091
原文	在 PubMed 查看原文 ↗
发表日期	2026
作者	Vanessa J Zhang 查看其他 8 位作者 Andrew W Liu；Maimuna Ahmad；Prithwijit Roychowdhury；Shervin Kamalian；Marc D Polanik；Cheryl Fikucki；Aaron K Remenschneider；Divya A Chari
作者单位	Department of Otolaryngology-Head & Neck Surgery, University of Massachusetts Chan Medical School, Worcester, MA, USA; Department of Otolaryngology-Head & Neck Surgery, UMass Memorial Medical Center, Worcester, MA, USA. 查看其他 7 条单位信息 Department of Otolaryngology-Head & Neck Surgery, University of California San Francisco, San Francisco, CA, USA.；Department of Otolaryngology-Head & Neck Surgery, Washington University School of Medicine, St Louis, MO, USA.；Department of Radiology, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA, USA.；Department of Otolaryngology-Head & Neck Surgery, Penn State College of Medicine & Milton S. Hershey Medical Center, Hershey, PA, USA.；Department of Audiology, UMass Memorial Medical Center, Worcester, MA, USA.；Department of Otolaryngology-Head & Neck Surgery, UMass Memorial Medical Center, Worcester, MA, USA; Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA; Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.；Department of Otolaryngology-Head & Neck Surgery, University of Massachusetts Chan Medical School, Worcester, MA, USA; Department of Otolaryngology-Head & Neck Surgery, UMass Memorial Medical Center, Worcester, MA, USA; Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA. Electronic address: divya_chari@meei.harvard.edu.
期刊	American journal of otolaryngology
SCI 分区	Q2
IF	1.8
研究类型	临床研究 · 临床
所属专科	耳科

中文摘要

目的： 评估术前听力检查或计算机断层扫描（CT）结果是否与耳硬化症初次镫骨切开术中因厚镫骨足板而转为微钻相关。
方法： 对136例成人初次镫骨切开术（2016-2025年）进行回顾性队列研究。病例分为仅激光组（n=94）与因厚足板转为微钻组（n=30）；因其他原因转为微钻者进行描述性分析（n=12）。进行了多变量logistic回归和受试者工作特征（ROC）分析。
结果： 厚足板微钻转换病例的术前气骨导差（ABG）大于仅激光病例（44.1±9.2 vs 39.4±10.7 dB；p=0.023）。ABG与微钻转换独立相关（校正OR 1.05每dB；AUC 0.64）。在CT亚组（n=72）中，窗前裂放射性密度无预测价值（p=0.83）。微钻转换的手术时间更长（75.3±21.5 vs 65.3±15.0分钟；p=0.018）。
结论： 较大的术前ABG与厚足板微钻转换有统计学关联，但区分能力一般，不应将其用于个体层面的预测。无论采用哪种技术，术后听力结果均保持良好。

英文摘要

OBJECTIVE: To evaluate whether preoperative audiometry or computed tomography (CT) findings are associated with intraoperative microdrill conversion for a thick stapes footplate during primary stapedotomy for otosclerosis.
METHODS: Retrospective cohort study of 136 adult primary stapedotomies (2016-2025). Cases were grouped as laser-only (n = 94) versus microdrill conversion due to thick footplate (n = 30); conversions for other reasons were analyzed descriptively (n = 12). Multivariable logistic regression and receiver operating characteristic (ROC) analysis were performed.
RESULTS: Thick-footplate microdrill conversion cases had a larger preoperative air-bone gap (ABG) than laser-only cases (44.1 ± 9.2 vs 39.4 ± 10.7 dB; p = 0.023). ABG was independently associated with microdrill conversion (adjusted OR 1.05 per dB; AUC 0.64). In the CT subset (n = 72), fissula ante fenestram radiodensity was not predictive (p = 0.83). Operative time was longer with microdrill conversion (75.3 ± 21.5 vs 65.3 ± 15.0 min; p = 0.018).
CONCLUSION: Larger preoperative ABG was statistically associated with thick-footplate microdrill conversion, but discriminative performance was modest and should not be used for individual-level prediction. Postoperative hearing outcomes remained favorable with either technique.