Department of Otolaryngology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Otol Neurotol. 2012 Oct;33(8):1445-51. doi: 10.1097/MAO.0b013e318268d4e0.
The protocol for bone-anchored hearing implants (e.g., Baha) surgery involves reduction of soft tissues around the abutment to minimize the risk of skin-related complications. It is hypothesized that good soft tissue outcomes may be achieved without performing skin reduction if improved abutment designs and/or materials are used that provide enhanced integration with surrounding soft tissues. The aim of the study was to investigate soft tissue response to different abutment designs/materials.
Thirty-six Baha implants and abutments were inserted in the skull of six sheep without performing soft tissue reduction. Four different abutments were used: 1) standard Baha abutments, 2) hydroxyapatite-coated standard Baha abutments, 3) concave titanium abutments, and 4) hydroxyapatite-coated concave abutments. Healing times of 1, 2, and 4 weeks were used (2 animals per time point). Samples were analyzed using descriptive histology and morphometric measurements, and results were compared using Wilcoxon's signed-ranked test.
Histologic assessment showed healthy soft tissues around the abutments with limited or no signs of inflammation. Hydroxyapatite-coated abutments showed tight adherence with dermis and limited epidermal downgrowth and pocket formation. Weaker adherence, often associated with significant epidermal downgrowth and pocket formation, was noted for noncoated titanium abutments. The mean pocket depth for abutment types A, B, C, and D was 1.38, 0.42, 1.51, and 0.24 mm, respectively. The difference between C and D was statistically significant (p = 0.031).
The results showed enhanced dermal adherence and reduced epidermal downgrowth and pocket formation for hydroxyapatite-coated abutments, with the most significant effect recorded for the hydroxyapatite-coated abutments with a concave shape.
骨锚式听力植入物（如 Baha）手术的方案包括减少围绕着植入体的软组织，以最大限度地降低与皮肤相关的并发症风险。假设如果使用提供与周围软组织更好整合的改进的植入体设计和/或材料，无需进行皮肤减少术也可以获得良好的软组织效果。本研究的目的是研究不同植入体设计/材料的软组织反应。
将 36 个 Baha 植入体和植入体插入 6 只绵羊的颅骨中，而不进行软组织减少术。使用了四种不同的植入体：1）标准 Baha 植入体，2）涂有羟基磷灰石的标准 Baha 植入体，3）凹面钛植入体，4）涂有羟基磷灰石的凹面植入体。使用 1、2 和 4 周的愈合时间（每个时间点 2 只动物）。使用描述性组织学和形态计量学测量对样本进行分析，并使用 Wilcoxon 符号秩检验比较结果。
组织学评估显示，植入体周围的软组织健康，炎症有限或没有。涂有羟基磷灰石的植入体与真皮紧密附着，表皮向下生长和口袋形成有限。未涂覆的钛植入体附着较弱，通常与明显的表皮向下生长和口袋形成相关。植入体类型 A、B、C 和 D 的平均口袋深度分别为 1.38、0.42、1.51 和 0.24mm。C 和 D 之间的差异具有统计学意义（p = 0.031）。
结果表明，涂有羟基磷灰石的植入体增强了真皮的附着，减少了表皮向下生长和口袋形成，其中凹面涂有羟基磷灰石的植入体效果最显著。
