鼓室硬化临床资料及其听骨链重建的研究

发布时间：2018-05-20 18:11

本文选题：鼓室硬化 + 性别　；参考：《南方医科大学》2010年硕士论文

【摘要】： 第一部分118例鼓室硬化临床资料分析目的通过鼓室硬化病人临床资料分析,探讨鼓室硬化的发病规律及影响听力的主要因素。为临床诊断和治疗提供一定的依据。方法 1.1临床资料：珠江医院2004年1月至2009年12月资料完整的鼓室硬化病例118例(137耳),及265例(311耳)慢性化脓性中耳炎的病例为对照组。所有病例均有慢性化脓性中耳炎病史。118例鼓室硬化病人中男38例,女80例,年龄12-66岁,平均(34.49±12.58)岁,对照组265例中男139例,女126例,年龄6-70岁,平均(35.53±13.12)岁。听力测试均采用同一型号电测听仪：美国GSI 61临床听力计。 1.2方法： 1.2.1主要观察指标：根据病史记录、手术记录、纯音听阈检查收集2004年1月至2009年5月我科收治的鼓室硬化病例完整资料118例。对照组记录同期慢性化脓性中耳炎(单纯型)入院治疗的所有患者性别、年龄、病程共265例,排除胆脂瘤型中耳炎及有手术外伤史病例。根据术前纯音听阈检查记录听力图的各频率气导和骨导的纯音听阈值。根据手术记录,分析鼓室硬化病例的鼓膜、听骨链和多部位钙化破坏情况,分别记录各部位有无钙化或破坏。 1.2.2听力学检测：各频率气导听阈(AC)、骨导听阈(BC)、言语频率纯音平均听阈(AC)及气骨导差(ABG),气导上限：120dB,骨导上限：80 dB,缺失、超出或未测出为缺失值。 1.2.3统计学处理：两组年龄、病程分布比较采用秩和检验,性别构成比比较采用χ2检验,各频率听力比较采用t检验,影响听力的因素比重分析采用TwoStep Cluster法。所有数据均采用SPSS13.0统计软件进行分析,检验水准α=0.05,双侧。结果 (1)鼓室硬化组与慢性化脓性中耳炎组比较两组患病年龄无差别,鼓室硬化组年龄中位数为32.5岁,对照组年龄中位数为34.0岁,Z=-0.667,P=0.505,鼓室硬化女性患病年龄较大,男性年龄中位数为29.0岁,女性年龄中位数为34.0岁,Z=-2.700,P=0.007。患病率女性38.8%,男性21.5%,Z=13.468,P=0.000,女性患病率较高。鼓室硬化组与对照组病程长短无差别,Z=0.703,P=0.482。鼓室硬化组男女病程分布无差别,Z=-1.703,P=0.089。(2)不同部位病变的发生率由高到低是：鼓膜(61.3%)、锤骨(56.2%)、砧骨(55.5%)、锤砧关节(34.1%)、其它部位(42.3%)、砧镫关节(29.2%)、镫骨(23.4%)。不同性别之间无统计差异。(3)纯音听阈检查听骨链有硬化或破坏的较听骨链正常组听力差,P0.05,当语频AC大于39.89 dB-54.68dB,语频ABG大于28.65dB36.55dB,考虑听骨链病变；女性较男性听力差,P0.05,感音神经性聋男性17.1%,女性38.5%,χ2=6.074,P=0.014(双侧)。女性伴有感音神经性聋发病率较男性的高。Carhart切迹出现率为32.85%,气导倒“V”形听力曲线出现率为34.31%,两组χ2检验无差异,χ2=0.065,P=0.798(双侧)。听力损失影响因素按比重,从大到小顺序为：砧骨、锤骨、锤砧关节、砧镫关节、镫骨、伴发病变、其它部位病变、鼓膜、性别。结论性别可能是鼓室硬化发病的影响因素之一,女性增加了鼓室硬化的发病危险。骨导carhart切迹与气导听力倒“V”形曲线可能是鼓膜和听骨链钙化的标志。听骨链病变对听力影响严重,按比重从大到小顺序为：砧骨、锤骨、锤砧关节、砧镫关节、镫骨等。处理好听骨链的重建是手术成败的关键,其中砧骨、锤骨病变是手术中最常处理的听骨病变。了解听力图特点,听骨链病变规律,对鼓室硬化的诊断及治疗有一定的帮助。关键词鼓室硬化；性别；纯音测听；听骨链第二部分多孔聚乙烯和生物陶瓷人工听骨在鼓室硬化手术中应用的疗效比较目的比较高分子多孔聚乙烯和生物陶瓷人工听骨在鼓室硬化手术中应用的疗效,分析手术并发症。方法 1.1临床资料：对珠江医院1992年至2009年患鼓室硬化锤砧固定型并接受手术治疗的患者进行随访。本研究33例鼓室硬化,男12例,女21例,年龄平均(32.33±11.98)岁。患者均有慢性中耳炎病史,病程平均(15.37±10.85)年,术前干耳1个月以上。随访时间为3-24月。所有患者根据术中锤骨、砧骨的固定、破坏情况使用PORP高分子多孔聚乙烯人工听骨17例,生物陶瓷人工听骨14例。听力测试均采用同一型号电测听仪：美国GSI 61临床听力计。人工听骨材料高分子多孔聚乙烯听骨赝复物(Sheehy Partial Ossicular Prosthesis,POP,美国美敦力公司)规格：L=4.75mm,HD=3.0mm,SID=1.17mm。生物陶瓷听骨(bioceramic middle ear devices,武汉华威生物材料工程开发公司)规格：PORP：高度有2.0mm、2.5mm、3.0mm、3.5mm、4.0mm五种,重量10、20mg。 1.2方法： 1.2.1手术方法：采用1%利多卡因加肾上腺素,浓度一般为200000：1,局部浸润麻醉,儿童或有全麻要求的给予全麻。注意鼓室内麻醉用量避免过大导致耳蜗和前庭功能障碍。麻醉成功后,手术采用鼓室成形术不伴乳突切开(No Mastoidectomy),耳道内切口从上12点,到下6点,弧形切开皮肤及骨膜,距鼓环6-8mm平面,作外耳道后壁皮瓣,骨膜下分离皮瓣,挑起鼓环进入鼓室,开放上鼓室暴露锤骨、砧骨,探查听骨链,锤、砧骨固定或破坏,镫骨完整且活动良好。如果鼓索神经妨碍操作予剪断,避免过分牵拉鼓索神经导致面神经损伤。将砧骨从锤骨头和镫骨头处分离,取出砧骨,然后于鼓膜内表面分离锤骨柄后取出锤骨,再次检查镫骨见其结构完整且活动良好。将听骨赝复物PORP一端套在镫骨头上,明胶海绵铺平鼓室至鼓环与听骨赝复物外端平面,取一耳屏软骨薄片或颞肌筋膜植入鼓膜内表面与听骨赝复物之间。颞肌筋膜取同侧耳廓上方发际上1.5-3cm的颞肌筋膜,取下后修剪、展开、压平,或加酒精固定。软骨薄片取自耳屏软骨,塑形削薄,带或不带软骨膜。复位鼓膜、皮瓣,碘仿砂条填塞术腔及外耳道。术后头部制动1-2d,预防喷嚏,常规抗感染等治疗,14d左右抽出外耳道碘仿纱条。 1.2.2主要观察指标：术后言语频率平均气导听阈(AC)、平均骨导听阈(BC)及气骨导差(ABG)值。 1.2.3听力检查及随访术前1-2d、术后3-24月行电测听,测试250、500、1000、2000、4000Hz气导和骨导。500、1000和2000Hz的均值作为言语平均纯音听闽(言语AC)。气骨导差(ABG)为同期言语频率气导减去骨导值。气导上限：120dB,骨导上限：80dB,超出、未测出者定为缺失值。术后听力以最后一次复查为准。术前行声导抗检查,咽鼓管吹张试验,所有病例咽鼓管通畅,必要时进行耳内镜检查,排除胆脂瘤病变。定期复诊,随访观察听骨赝复物有无脱出,听力有无下降,有无其他并发症等,预防感染,保持外耳道干洁。 1.2.4统计学处理：两组各变量均数指标的比较分析用t检验及协方差分析(ANCOVA),检验水准α=0.05,双侧检验。构成比比较用χ2检验,检验水准α=0.05,双侧检验。均用SPSS13.0软件包进行统计分析。结果两组言语频率(500Hz,1000Hz,2000Hz)手术前后气导、气骨导差值均有改善,有显著性差异(P0.05),但两组间手术疗效无显著差别(P0.05)；两组4KHz术后气导无明显改善。两组术后语频AC提高15dB以上占63.6%,ABG小于25dB占57.6%。生物陶瓷人工听骨脱出鼓膜1例,为单纯用颞肌筋膜修补鼓膜者。多孔聚乙烯人工听骨无脱出病例。采用软骨修补鼓膜者未出现听骨赝复物排出。移植新鼓膜无外侧愈合,除1例生物陶瓷听骨穿出鼓膜外其他无穿孔情况。术后外耳道狭窄1例,再次手术后无狭窄,听力无影响。患者均在术后1月内干耳,无再次感染。两组均无术后发生感音神经性聋。结论高分子多孔聚乙烯和生物陶瓷人工听骨都能够提高鼓室硬化患者的听力,短期疗效肯定,手术并发症少,是治疗鼓室硬化的有效方法。并发症预防需注意手术精细操作,人工听骨植入位置准确连接牢固,术后避免中耳感染减轻炎症反应；避免剧烈活动和大声环境预防人工听骨移位。
[Abstract]:Analysis of clinical data of 118 cases of tympanosclerosis in the first part

Purpose

Through the analysis of the clinical data of the patients with tympanosclerosis , the pathogenesis of tympanosclerosis and the main factors affecting hearing are discussed . It provides some basis for clinical diagnosis and treatment .

method

1.1 Clinical data : From January 2004 to December 2009 , 118 patients ( 137 ears ) and 265 ( 311 ears ) of chronic suppurative otitis media were enrolled in the clinical data . All the cases had a history of chronic suppurative otitis media .

1.2 Method :

1.2 . 1 Main observation indexes : From January 2004 to May 2009 , 118 cases of tympanosclerosis were collected from January 2004 to May 2009 according to the records of medical history , surgical notes and pure tone hearing thresholds . The control group recorded a total of 265 cases of chronic suppurative otitis media ( simple type ) admitted to hospital .

1.2 . 2 Listen to the mechanics test : the frequency air conduction threshold ( AC ) , the bone conduction threshold ( BC ) , the speech frequency pure tone average hearing threshold ( AC ) and the air - bone conduction difference , the upper limit of the gas conduction : 120 dB , the upper limit of the bone conduction : 80 dB , the missing , the excess , or the missing value .

1.2 . 3 Statistical treatment : The comparison of the age and the course distribution of the two groups adopts the rank sum test , and the sex ratio is compared with that of the comparison between the two groups . The comparison of the frequency hearing adopts the two - step Cluster method . All the data are analyzed by the SPSS 13.0 statistical software , and the test level is alpha = 0.05 , and the two sides are tested .

Results

( 1 ) There was no difference in the age between the tympanosclerosis group and the chronic suppurative otitis media group . The median age of the tympanosclerosis group was 32.5 years , the median age was 34.0 years , Z = - 0.667 , P = 0.505 . There was no statistical difference between the two groups .
The incidence of hearing loss was 32.85 % , 蠂 ~ 2 = 0.065 , P = 0.798 ( bilateral ) . The incidence of hearing loss was 32.85 % , 蠂 ~ 2 = 0.065 , P = 0.798 ( bilateral ) .

Conclusion

Sex may be one of the factors affecting the pathogenesis of tympanosclerosis , and women have increased the risk of tympanosclerosis . The bone conduction carhart notch and the " V " curve may be a sign of calcification of the tympanic membrane and the icular chain . The reconstruction of the icular chain is the key to the success or failure of the operation .
Gender ;
pure tone sounding ;
icular chain

Comparison of the therapeutic effect of the second part of porous polyethylene and bioceramic artificial auditory bone in tympanosclerosis surgery

Purpose

To compare the curative effect of high molecular porous polyethylene and bioceramic artificial auditory bone in tympanosclerosis surgery , and to analyze surgical complications .

method

1 . Clinical data : A follow - up study was carried out for patients with tympanosclerosis in the Pearl River Hospital from 1992 to 2009 and underwent surgical treatment . All patients had a history of chronic otitis media with a history of chronic otitis media ( 15.37 卤 10.85 ) years .

1.2 Method :

1.2 . 1 Operation method : 1 % lidocaine and adrenaline are used , the concentration is generally 200,000 : 1 , local infiltration anaesthesia , children or general anesthesia requires general anesthesia .

1.2 . 2 Main observation indexes : mean air - conduction threshold ( AC ) , mean bone conduction threshold ( BC ) and gas - bone - conduction - difference between postoperative speech frequency ( AC ) .

1.2 . 3 Hearing Check and Follow - up

The mean pure tone was measured at 250 , 500 , 1000 , 2000 , 4000 Hz and 500 , 1000 and 2000 Hz . The upper limit of air conduction was 120dB , the upper limit of bone conduction was 80dB , the upper limit of air conduction was 120dB , the upper limit of bone conduction was 80dB , and no one was identified as missing value .

1.2 . 4 Statistical treatment : The comparison and analysis of the mean indexes of the variables in the two groups were analyzed by t - test and covariance analysis ( ANCOVA ) , the level of test 伪 = 0.05 , and the double - sided test . The statistical analysis was carried out with SPSS 13.0 software package .

Results

There was no significant difference between the two groups ( P0.05 ) .
There was no significant improvement in postoperative air conduction between the two groups . After operation , the frequency AC of the two groups increased by 15dB or more , and it was less than 25dB and 57.6 % .

Conclusion

Both the polymer porous polyethylene and the bioceramic artificial bone can improve the hearing , short - term curative effect and few complications of the tympanosclerosis patients , and are an effective method for curing tympanosclerosis .
Avoid strenuous activity and loud environment to prevent artificial hearing loss .
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R764

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