Geyer G
Klinik für HNO-Heilkunde, Kopf- und Halschirurgie, Städtisches Klinikum Solingen.
HNO. 1999 Feb;47(2):77-91. doi: 10.1007/s001060050363.
To rehabilitate most cases of conductive hearing loss closure of ear drum perforations and rebuilding of the ossicular chain can be performed. Due to the great number of biocompatible bone substitute materials available it is occasionally difficult for the surgeon to choose the most favorable substitute. Autogenous structures (ossicles, cortical bone, cartilage) and allogenous tissues (ossicles, cortical bone, cartilage, dentin) are possible bone replacement materials. Xenogenic tissue is currently not used in middle ear surgery. Ionomer cement is a hybrid material for replacement of bone but does not fit direct classification of the various classes of alloplastic materials in current use: that is, metals (gold, steel wire, platinum, titanium), plastics (polyethylene, polytetrafluorethylene) and ceramics (ceramic oxide, carbon, calcium-phosphate ceramic, vitreous ceramic). For restoration of the sound conductive apparatus preference is given to autogenous ossicles because cortical bone is resorbed and cartilage weakens over time. Most surgeons do not use allogenous tissue, because of the possible transmission of such infectious disease as immunodeficiency syndrome or Creutzfeldt-Jakob disease. Only dentin deserves special attention as a possible bone substitute in the middle ear because its form can be preserved during sterilization. Based on the observations available to date, it becomes apparent that titanium implants hold greater promise than gold. Form-stable synthetic materials are not generally recommended due to foreign body reactions which have been confirmed by many investigators. Ceramic materials (e.g. ceramic oxide, carbon, calcium-phosphate ceramic, glass ceramic) are well tolerated in the middle ear and have also proved to be useful over time. Hybrid bone substitute ionomer cement is easily workable and well integrated, showing a good functional outcome. For many years good results in otosclerosis surgery have been achieved with a prosthesis made of platinum-wire and Teflon. Short-term follow-up periods hold great promise with pistons made of gold. Autogenous ossicles, ionomer cement and recently titanium protheses--as far as usable--are employed by the author for reconstructing the middle ear. For the time being platinum-Teflon prostheses and gold are used in otosclerosis surgery.
对于大多数传导性听力损失病例，可以进行鼓膜穿孔封闭和听骨链重建。由于有大量生物相容性骨替代材料可供选择，外科医生有时难以选择最适宜的替代物。自体结构（听小骨、皮质骨、软骨）和同种异体组织（听小骨、皮质骨、软骨、牙本质）都是可能的骨替代材料。目前异种组织不在中耳手术中使用。离子聚合物骨水泥是一种用于替代骨的混合材料，但不符合当前使用的各种异质材料的直接分类：即金属（金、钢丝、铂、钛）、塑料（聚乙烯、聚四氟乙烯）和陶瓷（陶瓷氧化物、碳、磷酸钙陶瓷、玻璃陶瓷）。对于声音传导装置的修复，优先选择自体听小骨，因为皮质骨会随着时间被吸收，软骨会变弱。大多数外科医生不使用同种异体组织，因为可能会传播诸如免疫缺陷综合征或克雅氏病等传染病。只有牙本质作为中耳可能的骨替代物值得特别关注，因为其形态在灭菌过程中可以保留。根据目前可得的观察结果，很明显钛植入物比金更有前景。由于许多研究者已证实的异物反应，一般不推荐使用形状稳定的合成材料。陶瓷材料（如陶瓷氧化物、碳、磷酸钙陶瓷、玻璃陶瓷）在中耳中耐受性良好，并且随着时间的推移也已证明是有用的。混合骨替代离子聚合物骨水泥易于操作且整合良好，显示出良好的功能结果。多年来，铂丝和聚四氟乙烯制成的假体在耳硬化症手术中取得了良好效果。金制活塞的短期随访前景广阔。作者使用自体听小骨、离子聚合物骨水泥以及最近的钛假体（只要可用）来重建中耳。目前，铂 - 聚四氟乙烯假体和金用于耳硬化症手术。
