Department of Otorhinolaryngology, Plastic Head and Neck Surgery, University Hospital of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
Eur Arch Otorhinolaryngol. 2010 Jul;267(7):1055-66. doi: 10.1007/s00405-009-1171-9. Epub 2009 Dec 2.
The objectives of this study were to determine whether autologous bone chips are suitable materials for canal wall reconstruction after cholesteatoma removal and to evaluate the effectiveness of a separate attic bone graft for the prevention or recurrent cholesteatomas using prospective study of two consecutive patient series (29/31 unselected patients with an average follow-up of 36.3 +/- 11.1/21.5 +/- 6.3 months) and retrograde resection of the posterior-superior canal wall followed by reconstruction of the canal defect using one or more temporal squama bone chips. In the second series, lateral attic wall reconstruction and pars flaccida reinforcement was established by a notched bony attic strut attached onto the neck and short process of the malleus for structural support. In the first series, the rate of recurrent cholesteatomas (17.3%), in particular of attic retraction pockets (31%), was significantly high. The average postoperative air-bone gap was 6.4 +/- 6.3 dB in type-I tympanoplasty (TP), 8.7 +/- 3.4 dB in type-III TP with intact stapes suprastructure, and 16.4 +/- 9.3 dB in type-III TP with TORP, respectively. In the second series, recurrent cholesteatoma and retraction pocket rate could be decreased to 9.7 and 6.5%, respectively. The postoperative air-bone gap was 7.5 +/- 5.1 dB HL in type-I tympanoplasty (TP), 11.6 +/- 4.9 dB HL in type-III (PORP) TP, and 17.9 +/- 12.2 dB HL in type-III (TORP) TP. Connecting the attic strut to the malleus neck did not affect the malleus mobility and hearing outcome. Osteoplastic atticoantrotomy with autologous bone chip reconstruction enables a tailor-made anatomical and physiological reconstitution of the auditory ear canal, thus enhancing the acoustic properties. Precise reconstruction of the lateral attic wall and reinforcement of the superior part of the tympanic membrane seems to be important for the prevention of retraction pockets and subsequent recurrent cholesteatoma development.
本研究旨在确定自体骨屑是否适合作为胆脂瘤切除术后重建鼓室侧壁的材料，并通过前瞻性研究两个连续患者系列（29/31 例未经选择的患者，平均随访 36.3 +/- 11.1/21.5 +/- 6.3 个月）和逆行切除后上鼓室外侧壁，使用一个或多个颞鳞骨屑重建鼓室缺损，评估单独使用后上鼓室骨移植对于预防或复发性胆脂瘤的效果。在后一个系列中，通过附着在颈和锤骨短突上的带缺口的骨性鼓室支柱来建立外侧鼓室壁重建和鼓膜松弛部加固，以提供结构支撑。在前一个系列中，复发性胆脂瘤（17.3%），尤其是鼓室上隐窝（31%）的发生率非常高。I 型鼓室成形术（TP）的平均术后气骨导差为 6.4 +/- 6.3dB，III 型 TP 中完整镫骨上结构的气骨导差为 8.7 +/- 3.4dB，III 型经镫骨底板切除后重建术（TORP）的气骨导差为 16.4 +/- 9.3dB。在后一个系列中，复发性胆脂瘤和鼓室上隐窝的发生率可分别降低至 9.7%和 6.5%。I 型鼓室成形术（TP）的术后气骨导差为 7.5 +/- 5.1dBHL，III 型（PORP）TP 的气骨导差为 11.6 +/- 4.9dBHL，III 型（TORP）TP 的气骨导差为 17.9 +/- 12.2dBHL。将鼓室支柱与锤骨颈连接不会影响锤骨的活动度和听力结果。使用自体骨屑进行鼓室成形术和重建可实现听觉耳道的定制化解剖学和生理学重建，从而提高声学性能。外侧鼓室壁的精确重建和鼓膜上部的加固对于预防鼓室上隐窝和随后的复发性胆脂瘤发展似乎很重要。
