Desaulty A, Shahsavari S, Pasquesoone X
CHU, Hôpital Huriez, Service ORL, 59000 Lille, France.
Rev Laryngol Otol Rhinol (Bord). 2005;126(1):19-23.
The prostheses known as biocompatible are usually proposed for columellar repair in absence of stapes but at which cost and which long-term tolerance? It appeared useful to study the possibilities of autograft ossicular reconstruction (incus and cortical bone) in absence of suprastructure of the stapes.
Retrospective study for 82 operated patients for cholesteatoma with lysis of the cruras of the stapes. Columellar repair was obtained by prosthesis, columella of cortical mastoid bone, and more often autograft of incus (54 cases). The technique of Autogreffe Tympanum-Cartilage-Os-Platinum (ATCOP) (Autograft Tympanum-Cartilage-Bone-Footplate is described: tympanic repair by fascia and cartilage from the concha is made at the first surgical step. Type III ossiculoplasty is performed at the second look. The distance tympanum-footplate is then lower than 6 mm and the body of the incus, preserved as a spare ossicle in the mastoid, has a sufficient length to be interposed in between new drum and footplate.
78% of the patients have final air bone gap less or equal than 30 decibels. The average post op air bone gap is 23 decibels with incus while it was 42 decibels before surgery. Average gain is 19 decibels. The cost of autograft is null and tolerance is excellent.
Patient's incus is usable in type III ossiculoplasty thanks to a cartilage graft of the tympanic membrane. Patient's ossicle is a material of choice for columellar repair even in absence of the suprastructure of the stapes. Prostheses in biomaterial appear justified in case of absent or destroyed incus.
通常建议使用所谓的生物相容性假体进行镫骨缺失时的小柱修复，但代价是什么以及长期耐受性如何？研究在镫骨上部结构缺失时自体骨重建（砧骨和皮质骨）的可能性似乎很有必要。
对82例因胆脂瘤行镫骨脚弓松解术的手术患者进行回顾性研究。通过假体、皮质乳突骨小柱，更常见的是砧骨自体移植（54例）来实现小柱修复。描述了鼓膜 - 软骨 - 骨 - 铂自体移植技术（ATCOP）（鼓膜 - 软骨 - 骨 - 镫骨底板自体移植）：第一步手术用来自耳甲的筋膜和软骨进行鼓膜修复。在二次探查时进行III型听骨链成形术。此时鼓膜与镫骨底板之间的距离小于6mm，保留在乳突中作为备用听小骨的砧骨体有足够的长度插入新鼓膜和镫骨底板之间。
78%的患者最终气骨导差小于或等于30分贝。砧骨自体移植术后平均气骨导差为23分贝，而术前为42分贝。平均增益为19分贝。自体移植的成本为零且耐受性极佳。
由于鼓膜软骨移植，患者的砧骨可用于III型听骨链成形术。即使在镫骨上部结构缺失的情况下，患者的听小骨也是小柱修复的首选材料。在砧骨缺失或破坏的情况下，生物材料假体似乎是合理的。
