逆转式与经典镫骨开窗术治疗耳硬化症的比较：系统评价与荟萃分析
Reversal versus classic stapedotomy for otosclerosis: a systematic review and meta-analysis.
文献信息
| PMID | 42867653 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Ebraheem Albazee |
| 作者单位 | Otorhinolaryngology-Head and Neck Surgery, Kuwait Institute for Medical Specializations (KIMS), Kuwait City, Kuwait. Ebraheemalbazee@gmail.com. |
| 期刊 | European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery |
| SCI 分区 | Q1 |
| IF | 2.3 |
| 研究类型 | 综述 Meta · 临床 |
| 所属专科 | 耳科 |
中文摘要
背景： 镫骨开窗术是耳硬化症的标准手术干预方式，但最佳手术步骤顺序仍存在争议。本系统评价与荟萃分析旨在比较逆转式与经典镫骨开窗术治疗耳硬化症的疗效与安全性。
方法： 对五个数据库进行了全面检索，截至2026年2月，纳入随机对照试验（RCT）和非随机研究（NRS）。主要结局为听力成功，定义为气骨导差（ABG）闭合至≤10 dB。次要结局包括连续听力学参数和手术并发症。采用随机效应模型合并风险比（RR）和均数差（MD）。
结果： 共纳入10项研究（2项RCT，8项NRS），涉及1,540例患者。在实现ABG≤10 dB方面，逆转式与经典技术之间无显著差异（RR：1.02，95% CI [0.93, 1.13]）。虽然术后ABG（MD：-1.57 dB，95% CI [-2.59, -0.54]）和术后气导纯音平均听阈（MD：-1.86 dB，95% CI [-3.17, -0.55]）在统计学上显著 favoring 逆转式入路，但这些差异缺乏临床意义。在安全性方面，未观察到统计学显著差异，尽管逆转式入路显示出减少浮动底板（RR：0.23，95% CI [0.04, 1.24]）和鼓索神经损伤（RR：0.54，95% CI [0.29, 1.00]）的有利趋势。
结论： 逆转式与经典镫骨开窗术显示出可比的听力学结局，在所评估的安全性结局中未观察到统计学显著差异。然而，听力学结局的证据确定性较低，并发症的证据确定性极低，在进一步大规模RCT可用之前无法得出确定性结论。
英文摘要
BACKGROUND: Stapedotomy is the standard surgical intervention for otosclerosis, but the optimal sequence of surgical steps remains debated. This systematic review and meta-analysis aims to compare the efficacy and safety of reversal versus classic stapedotomy for otosclerosis.
METHODS: A comprehensive search across five databases was conducted up to February 2026 for randomized controlled trials (RCTs) and non-randomized studies (NRS). The primary outcome was audiological success, defined as air-bone gap (ABG) closure to ≤ 10 dB. Secondary outcomes included continuous audiometric parameters and surgical complications. Risk ratios (RRs) and mean differences (MDs) were pooled using a random-effects model.
RESULTS: Ten studies (2 RCTs, 8 NRS) involving 1,540 patients were included. There was no significant difference between the reversal and classic techniques in achieving an ABG ≤ 10 dB (RR: 1.02, 95% CI [0.93, 1.13]). While statistically significant differences favored the reversal approach for postoperative ABG (MD: -1.57 dB, 95% CI [- 2.59, - 0.54]) and postoperative air conduction pure-tone average (MD: -1.86 dB, 95% CI [- 3.17, - 0.55]), these differences lacked clinical significance. Regarding safety, no statistically significant differences were observed, although the reversal approach showed favorable trends toward reduced floating footplates (RR: 0.23, 95% CI [0.04, 1.24]) and chorda tympani injuries (RR: 0.54, 95% CI [0.29, 1.00]).
CONCLUSION: Reversal and classic stapedotomy demonstrate comparable audiological outcomes, with no statistically significant differences observed in the assessed safety outcomes. However, the certainty of evidence was low for audiological outcomes and very low for complications, precluding definitive conclusions until further large-scale RCTs are available.