Colletti V, Fiorino F G
ENT Department, University of Verona, Italy.
Otolaryngol Head Neck Surg. 1999 Mar;120(3):437-44. doi: 10.1016/S0194-5998(99)70288-3.
Absence of the long process of the incus with or without absence of the stapes head accounts for more than 80% of ossicular discontinuities. Total or partial replacement prostheses, made of various materials, are interposed to restore the transfer function of the middle ear. To simplify ossicular reconstruction, reduce operative times and costs, improve functional outcomes, and avoid the risk of infections, we have adopted, during the past 10 years, a technique that makes use of a personally designed alloplastic prosthetic device. The prosthesis connects the malleus to the footplate, even in the presence of the stapes superstructure. This malleus-to-footplate prosthesis consists in a plastipore-coated steel piston and hydroxyapatite head, complete with a groove. The groove is placed beneath the malleus neck after dissection of the tensor tympani tendon and the shaft of the piston on the footplate. Two hundred ninety primary ossiculoplasties with the malleus-to-footplate prostheses were performed in 265 patients from 1986 to 1995 in the ENT Department of the University of Verona. The average postoperative air-bone gap at 0.5 to 3 kHz was 11 dB at 1 year and 14 dB at 5 years. These outcomes are significantly better than those personally obtained previously with ossicular or alloplastic prostheses. No extrusions occurred. The structural characteristics of the malleus-to-foot-plate prosthesis endow the prosthesis with a high degree of biocompatibility and stability and optimal sound-transfer function. The rationale for this particular ossiculoplasty procedure is discussed.
砧骨长突缺如伴或不伴镫骨头缺如占听骨链中断的80%以上。采用由各种材料制成的全听骨或部分听骨赝复物来恢复中耳的传音功能。为了简化听骨链重建、减少手术时间和费用、改善功能结果并避免感染风险，在过去10年中，我们采用了一种利用个人设计的异体听骨赝复装置的技术。即使存在镫骨上部结构，该赝复物也能将锤骨与镫骨底板连接起来。这种锤骨-镫骨底板赝复物由一个涂有塑料微孔的钢活塞和羟基磷灰石头部组成，并带有一个凹槽。在切断鼓膜张肌腱后，将凹槽置于锤骨颈下方，活塞柄置于镫骨底板上。1986年至1995年，在维罗纳大学耳鼻喉科对265例患者进行了290次使用锤骨-镫骨底板赝复物的初次听骨链成形术。术后1年0.5至3kHz的平均气骨导差为11dB，5年时为14dB。这些结果明显优于以前使用听骨或异体听骨赝复物时个人获得的结果。未发生赝复物脱出。锤骨-镫骨底板赝复物的结构特性使其具有高度的生物相容性和稳定性以及最佳的传音功能。本文讨论了这种特殊听骨链成形术的原理。
