胆脂瘤听骨链重建术后的听力结局：自体与假体重建的回顾性比较。
Hearing outcomes after ossiculoplasty for cholesteatoma: A retrospective comparison of autologous versus prosthetic reconstructions.
文献信息
| PMID | 42867654 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Caroline Crampon |
| 作者单位 | Department of Otorhinolaryngology Head and Neck Surgery, CHU Rouen, Rouen, 76000, France. |
| 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 | 临床研究 · 临床 |
| 所属专科 | 耳科 |
中文摘要
目的： 比较胆脂瘤患者中自体与假体听骨链重建术后的听力结局。
主要终点： 使用自体材料（软骨或砧骨间置）或部分及全钛假体进行听骨链重建后，纯音平均气骨导差（ΔPTA-ABG）的术后变化。
方法： 分析2015年至2023年间在一家法国大学医院因慢性中耳炎伴胆脂瘤（COM-C）接受鼓室成形术联合听骨链重建术的312例成年患者，分为两组：自体重建组（n=192）和假体重建组（n=120）。ΔPTA-ABG（500-3000 Hz）为主要结局，次要终点包括250-4000 Hz的气导阈值。收集术前和术后（≥6个月）的听力学数据。采用单因素和多因素线性回归分析，并校正既往耳部手术、手术入路和手术时机等混杂因素。
结果： 自体重建组（3.3±11.6 dB）与假体重建组（4.6±13.0 dB）之间的ΔPTA-ABG无显著差异（p=0.37）。频率特异性分析显示，仅在250 Hz处ΔABG存在显著差异（p=0.02）。假体重建在250 Hz（p=0.04）、500 Hz（p=0.02）和1000 Hz（p=0.05）的气导阈值改善更大，而在更高频率未观察到差异。假体组术前阈值更差（p=0.009）。多因素分析证实ΔPTA-ABG变异不存在其他预测因素。
结论： 尽管假体组基线疾病更为晚期，自体与假体听骨链重建术与相当的气骨导差改善相关。鉴于该回顾性设计固有的残余混杂，这些发现应解释为改善程度相当，而非重建材料之间等效性的证明。
英文摘要
OBJECTIVE: To compare hearing outcomes between autologous and prosthetic ossiculoplasty in patients with cholesteatoma.
PRIMARY ENDPOINT: Postoperative change in pure-tone average air-bone gap (ΔPTA-ABG) following ossicular chain reconstruction using either autologous materials (cartilage or incus interposition) or partial and total titanium prostheses.
METHODS: Analyze of 312 adult patients who underwent tympanoplasty with ossiculoplasty for COM-C between 2015 and 2023 at a French university hospital, divided into two groups: autologous reconstruction (n = 192) and prosthetic reconstruction (n = 120). ΔPTA-ABG (500-3000 Hz) was the primary outcome, with secondary endpoints including air conduction thresholds at 250-4000 Hz. Audiometric data were collected pre- and postoperatively (≥ 6 months). Univariate and multivariate linear regression analyses adjusted for confounders such as prior ear surgery, surgical approach, and operative timing.
RESULTS: No significant difference in ΔPTA-ABG was found between autologous (3.3 ± 11.6 dB) and prosthetic (4.6 ± 13.0 dB) reconstructions (p = 0.37). Frequency-specific analysis showed a significant ΔABG difference only at 250 Hz (p = 0.02). Prosthetic reconstruction demonstrated greater improvement in air conduction thresholds at 250 Hz (p = 0.04), 500 Hz (p = 0.02), and 1000 Hz (p = 0.05), while no differences were observed at higher frequencies. Preoperative thresholds were worse in the prosthetic group (p = 0.009). Multivariate analysis confirmed the absence of additional predictors of ΔPTA-ABG variance.
CONCLUSION: Despite more advanced baseline disease in the prosthetic group, autologous and prosthetic ossiculoplasty were associated with comparable air-bone gap improvement. Given the residual confounding inherent to this retrospective design, these findings should be interpreted as comparable improvement rather than as proof of equivalence between reconstruction materials.