Quaranta N, Fernandez-Vega Feijoo S, Piazza F, Zini C
Clinica Otorinolaringoiatrica e Microchirurgia Otologica, Otoneurologica e della Base Cranica, Universitá degli Studi di Parma, Italy.
Eur Arch Otorhinolaryngol. 2001 Jan;258(1):20-4. doi: 10.1007/s004050000300.
The aim of this retrospective study was to evaluate the long-term hearing results of using costal cartilage prostheses in ossicular chain reconstruction procedures in subjects operated on for a middle ear cholesteatoma with an intact canal wall tympanoplasty. Thirty-six patients (four with bilateral disease) followed up for 10 years who underwent an ossiculoplasty with a cartilage prostheses between January 1987 and December 1989 constituted the population studied. All the subjects underwent a staged intact canal wall tympanoplasty with mastoidectomy. Ossiculoplasty with total or partial chondroprosthesis was performed during the second stage. The long-term outcome was evaluated in terms of hearing according to the guidelines of the Committee on Hearing and Equilibrium (1995), and in terms of complications (anatomical and functional). In 18 patients a partial cartilage ossicular replacement prosthesis (PORP) was used, while in 22 a total cartilage ossicular replacement prosthesis (TORP) was used. In the PORP group the mean preoperative air-bone gap (ABG) was 22.4 dB hearing level (HL); before the second stage the ABG was 37.9 dB HL, at 2 years it was 12.1 dB HL, at 5 years 15.3 dB HL and at 10 years 15.8 dB HL. In the TORP group the mean preoperative ABG was 31.6 dB HL; before the second stage the ABG was 41.1 dB HL, at 2 years it was 14.4 dB HL, at 5 years 17 dB HL and at 10 years 18.5 dB HL. In both groups the number of cases with a postoperative ABG of < 20 dB HL remained stable (P > 0.05) over time. The failure rate was 17.5%, but only in 5% of cases was a functional revision needed. No cases of extrusion of the prostheses were encountered. The use of a chondroprosthesis is associated with functional results similar to those obtained by other authors. The efficacy of the prostheses remains stable over time and is associated with a very low rate of complications and failures. In this series no extrusion occurred and in no case did an infectious disease develop after cartilage transplantation.
本回顾性研究的目的是评估在完整外耳道壁鼓室成形术治疗中耳胆脂瘤的手术中，使用肋软骨假体进行听骨链重建手术的长期听力结果。1987年1月至1989年12月期间接受软骨假体听骨成形术的36例患者（4例双侧患病），随访10年，构成了研究人群。所有受试者均接受了分期的完整外耳道壁鼓室成形术加乳突切除术。在第二阶段进行全或部分软骨假体听骨成形术。根据听力与平衡委员会（1995年）的指南，从听力方面以及并发症（解剖和功能方面）评估长期结果。18例患者使用了部分软骨听骨置换假体（PORP），22例使用了全软骨听骨置换假体（TORP）。在PORP组中，术前平均气骨导差（ABG）为22.4 dB听力级（HL）；在第二阶段前ABG为37.9 dB HL，2年时为12.1 dB HL，5年时为15.3 dB HL，10年时为15.8 dB HL。在TORP组中，术前平均ABG为31.6 dB HL；在第二阶段前ABG为41.1 dB HL，2年时为14.4 dB HL，5年时为17 dB HL，10年时为18.5 dB HL。两组中术后ABG < 20 dB HL的病例数随时间保持稳定（P > 0.05）。失败率为17.5%，但仅5%的病例需要进行功能性翻修。未遇到假体脱出的病例。使用软骨假体获得的功能结果与其他作者相似。假体的疗效随时间保持稳定，且并发症和失败率极低。在本系列中未发生假体脱出，软骨移植后也未发生感染性疾病。
