Fisch Ugo, May John, Linder Thomas, Naumann Ilka Charlotte
ORL-Center, Klinik Hirslanden, Zurich.
Otol Neurotol. 2004 Nov;25(6):891-902. doi: 10.1097/00129492-200411000-00007.
To describe the technique used for total ossiculoplasty with the Fisch titanium total prosthesis and evaluate the 1-year postoperative functional results in patients presenting with the stapes (or footplate) without the malleus handle.
Prospective trial with preoperative and postoperative comparison.
Academic and private practice tertiary care center for otologic surgery.
Forty-nine consecutive patients operated on from September 1996 to December 2000.
: Staged ossicular reconstruction with a Fisch titanium total prosthesis placed between the footplate and the tympanic membrane without regard to the presence or absence of the stapes arch. Coupling of the prosthesis to the footplate was achieved by various techniques, including perforation, foot and spike on the footplate without perforation, and shaft alone (without foot) with tragal cartilage fixation (disc or small wedges). There was no interposition of cartilage between the prosthesis head and the tympanic membrane.
Pre- and postoperative air and bone-conduction thresholds and air-bone gaps for pure-tone averages of three and four frequencies and for single frequencies.
Postoperative air-bone gap closures within 20 dB distributed equally (50%) between 0.5, 1, and 4 kHz and reached the highest rate (89%) at 2 kHz (p < 0.05). The postoperative air-bone gaps for pure-tone averages reached 0 to 20 dB in 57% and 0 to 30 dB in 87% of the cases. There were no dead ears and no partial or total extrusions of prostheses. The best functional results were achieved through perforation coupling of the spiked foot to the footplate in large oval windows and after fixation of the shaft (without foot) with tragal cartilage disc in narrow oval windows.
The functional results of the L-shaped Fisch titanium total prosthesis implanted in ears with the stapes but no malleus handle are best at 2 kHz and better than those of comparable columellar titanium prostheses over the remaining tested frequencies.
描述使用菲施钛质全听骨假体进行全听骨成形术的技术，并评估镫骨（或镫骨底板）存在但锤骨柄缺失患者术后1年的功能结果。
术前与术后对比的前瞻性试验。
耳科手术的学术及私人三级护理中心。
1996年9月至2000年12月连续接受手术的49例患者。
采用菲施钛质全听骨假体进行分期听骨链重建，将假体置于镫骨底板与鼓膜之间，不考虑镫骨弓是否存在。通过多种技术实现假体与镫骨底板的连接，包括穿孔、在镫骨底板上无穿孔的足板及尖部、单独的杆部（无足板）与耳屏软骨固定（圆盘或小楔形）。假体头部与鼓膜之间未置入软骨。
术前及术后三个和四个频率的纯音平均值以及单频率的气导和骨导阈值和气骨导间距。
术后气骨导间距在20 dB内闭合的情况在0.5、1和4 kHz之间均匀分布（各占50%），在2 kHz时达到最高闭合率（89%）（p < 0.05）。纯音平均值的术后气骨导间距在57%的病例中达到0至20 dB，在87%的病例中达到0至30 dB。无耳失聪病例，也无假体部分或全部脱出。在大椭圆形窗中通过带尖足板与镫骨底板的穿孔连接以及在窄椭圆形窗中用耳屏软骨圆盘固定杆部（无足板）可获得最佳功能结果。
植入镫骨存在但锤骨柄缺失耳内的L形菲施钛质全听骨假体在2 kHz时功能结果最佳，在其余测试频率下优于类似的柱状钛质假体。
