Tos改良联合进路钛听骨植入鼓室成形的疗效观察*

Clinical analysis of Tos modified combined approach tympanoplasty with titanic ossicular reconstruction*

摘要:

摘要：目的??观察符合条件的慢性化脓性中耳炎患者行Tos改良联合入路清理病变并一期植入钛人工听骨行鼓室成形的效果。方法?回顾性分析34例在该院施行Tos改良联合入路乳突开放并植入钛人工听骨行鼓室成形的慢性化脓性中耳炎病例，总结患者手术前后听力及影像学特点，观察手术前后言语频率气导听阈变化。结果?以术中听骨破坏情况分组，镫骨板上结构缺失组植入全听骨赝复体（TORP）后听力改善（36.25±6.12）dB HL；砧蹬关节中段组植入部分听骨赝复体（PORP）后听力改善（13.18±3.37）dB HL。术后无钛听骨移位、感染，听力改善有效率97.06%（P?<0.05）。1～3个月全部干耳。结论?Tos改良联合入路鼓室成形并一期植入钛人工听骨能有效地清理中耳病变，尤其是清理后鼓室的隐匿病变，并有效提高听力，术前高分辨率CT（HRCT）发现乳突气化不良，尤其有乙状窦前移、脑板低位和面神经低位等不利于暴露的解剖变异时，可优先选择此术式。

Abstract:

Abstract: Objective?To explore the effect of Tos modified combined approach tympanoplasty with titanic ossicular reconstruction for chronic otitis media patients under certain conditions.?Methods?A retrospective review of clinical records of 34 chronic otitis media patients with Tos modified combined approach mastoidectomy tympanoplasty with titanic ossicular reconstruction were performed. Outcomes of conduction hearing threshold (PTA) in speech frequency of each patient before and after operation, the features of the temporal computed tomography (CT) scans, and the postoperative complications were reviewed.?Results?According to the ossicular conditions exploring in the operation, patients were divided into two groups. In non-suprastructure of stapes group, the PTA had decreased (36.25?±?6.12) dB HL after TORP transplantation. In ossicular-false-connection group, the PTA had decreased (13.18?±?3.37) dB HL with PORP replacement, effective rate of hearing increase was 97.06% (P?