Gołabek Wiesław, Szymański Marcin, Siwiec Henryk, Morshed Kamal
Otolaryngology Department, Medical University of Lublin.
Ann Univ Mariae Curie Sklodowska Med. 2003;58(1):302-5.
Stapedectomy is a safe surgical procedure used in patients with otosclerosis. However, complications may occur and decrease hearing gain after the operation. The aim of the work was to analyze hearing results in patients with incus subluxation during stapedectomy. In 15 (5%) of 292 patients with otosclerosis, the incus was unintentionally luxated during surgery. In one patient the incus was completely dislocated and malleovestibulopexy with autoincus had to be applied. In 14 stapedectomies the incus was subluxated and though it was pathologically mobile it was held in position by its ligaments. This situation allowed delicate reposition of the incus and insertion of the piston prosthesis on the long incus process. Mean AC threshold improved by 24 dB. Mean ABG improved from 34.6+/-8.3 dB before to 13.1+/-6.3 dB 8 months after stapedectomy (t=9.7; p<0.0001). Ten years after surgery average ABG was 10.6+/-4.4, which means stable hearing result. In 6 patients including the individual with complete incus luxation, postoperative ABG was less than 10 dB. In 9 patients postoperative ABG was between 10 and 15 dB. When the incus is subluxated good hearing results can be expected after insertion of the prosthesis on the repositioned incus.
镫骨切除术是用于耳硬化症患者的一种安全的外科手术。然而，术后可能会出现并发症并降低听力增益。这项研究的目的是分析镫骨切除术中砧骨半脱位患者的听力结果。在292例耳硬化症患者中，有15例（5%）在手术过程中砧骨意外脱位。有1例患者砧骨完全脱位，不得不采用自体砧骨的锤骨前庭固定术。在14例镫骨切除术中，砧骨半脱位，虽然其在病理上可活动，但由其韧带维持在原位。这种情况使得能够精细地复位砧骨并将活塞型人工镫骨植入砧骨长突。平均气导阈值提高了24 dB。平均气骨导差从镫骨切除术前的34.6±8.3 dB改善至术后8个月的13.1±6.3 dB（t = 9.7；p < 0.0001）。术后10年平均气骨导差为10.6±4.4，这意味着听力结果稳定。在包括砧骨完全脱位患者在内的6例患者中，术后气骨导差小于10 dB。在9例患者中，术后气骨导差在10至15 dB之间。当砧骨半脱位时，在复位后的砧骨上植入人工镫骨后有望获得良好的听力结果。
