Department of Otolaryngology/Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA.
Otol Neurotol. 2011 Apr;32(3):444-7. doi: 10.1097/MAO.0b013e31820e6daf.
To determine what factors increase the likelihood of osseointegration failure and implant extrusion with the use of osseointegration surgical hardware, for bone-anchored hearing aids (BAHAs), in children and adults.
A total of 60 patients (42 pediatric [≤19 yr] and 18 adult patients [34-69 yr]) who received osseointegration surgical hardware for a BAHA at Arkansas Children's Hospital from October 2003 to May 2009 or at the University of Arkansas for Medical Sciences from November 2005 to May 2009, respectively.
BAHA placement using 3- and 4-mm fixtures.
Osseointegration failure with implant extrusion.
Fifty-seven loaded fixtures in the pediatric population, and 20 were placed in the adults. We had a 21% pediatric and 0% adult osseointegration failure rate.
Young age, syndromic status, and failure to penetrate the inner table of the cranium increased the risk of osseointegration failures in children. In some cases, skull thickness provides an inadequate amount of bone for 4-mm fixture placement requiring placement of a 3-mm fixture instead. In these cases, transcalvarial placement of the implanted fixture may decrease the extrusion rate as 3-mm fixtures have been associated with increased rates of implant extrusion. The 3-mm fixtures that were placed in a transcalvarial fashion had a decreased extrusion rate compared with 3-mm fixtures that were surrounded by bone and did not penetrate the inner table of the cranium. Individual patient factors out of the surgeon's control likely play a large role in osseointegration failures as well. This clinical case report encourages transcalvarial fixture insertion when using 3-mm fixtures during placement of osseointegration surgical hardware for BAHAs.
确定在儿童和成人中使用骨整合手术硬件（骨锚式助听器（BAHA））时，哪些因素会增加骨整合失败和植入物挤出的可能性。
共有 60 名患者（42 名儿科患者[≤19 岁]和 18 名成年患者[34-69 岁]），他们分别于 2003 年 10 月至 2009 年 5 月在阿肯色儿童医院或 2005 年 11 月至 2009 年 5 月在阿肯色大学医学科学系接受 BAHA 骨整合手术硬件。
使用 3 毫米和 4 毫米的固定装置进行 BAHA 放置。
植入物挤出的骨整合失败。
在儿科人群中，57 个加载的固定装置中有 20 个被植入成人。我们的儿科骨整合失败率为 21%，而成年组为 0%。
年龄较小、综合征状态和未能穿透颅骨内板会增加儿童骨整合失败的风险。在某些情况下，颅骨厚度为 4 毫米的固定装置提供的骨量不足，需要放置 3 毫米的固定装置。在这些情况下，植入物的经颅骨放置可能会降低挤出率，因为 3 毫米的固定装置与植入物挤出率增加有关。以经颅骨方式放置的 3 毫米固定装置的挤出率低于被骨包围且未穿透颅骨内板的 3 毫米固定装置。超出外科医生控制的个别患者因素可能在骨整合失败中也起着重要作用。本临床病例报告鼓励在放置骨整合手术硬件以进行 BAHA 时，当使用 3 毫米固定装置时，采用经颅骨固定装置插入。
