Gérard Jean-Marc, De Bie Gersende, Franceschi Daniel, Deggouj Naima, Gersdorff Michel
Department of ENT and Head and Neck Surgery, Saint-Luc University Hospital, 1200, Brussels, Belgium,
Eur Arch Otorhinolaryngol. 2015 Jul;272(7):1629-35. doi: 10.1007/s00405-014-2975-9. Epub 2014 Mar 11.
The main objective of this study is to analyze results obtained with hydroxyapatite bone cement (HABC) ossiculoplasties. This is a retrospective study of a case series. This study was conducted in an academic hospital and tertiary referral center. A total of 127 ossiculoplasties using HABC were evaluated. Ears were divided into three groups according to procedure: group 1 involved reinforcement of the incudostapedial joint with cement and reconstruction of an incus long process defect with cement. Group 2 involved partial ossicular reconstruction between the stapes and malleus handle with HABC. Group 3 was divided into two subgroups. Group 3B entailed reconstruction of the stapes with a mobile footplate (Austin-Kartush type B = group 3B) and group 3F with a fixed footplate (Austin-Kartush type F = group 3F) using a K-Helix piston (Grace Medical, Memphis, TN, USA) or a classical titanium piston (Kurz, Fuerth, Germany) glued to the incus remnant or malleus handle with cement. Anatomical and pre- and postoperative audiological results were assessed. The mean follow-up was 26 ± 14 months. Percentages of average postoperative air-bone gap ≤ 20 dB were 95, 82.5, 50 and 83.3%, and for air-bone gap ≤ 1 0 dB, 80, 50.9, 16.6 and 50% for groups 1, 2, 3B and 3F, respectively. No complications related to the cement or extrusion occurred. Hearing outcomes also remained stable over time. In our experience, ossiculoplasty with cement provides good and stable functional results, is safe, cost effective, and easy to use. HABC with or without biocompatible ossicular prostheses allows repair of different types of ossicular defects with preservation of the anatomical and physiological ossicular chain, as well as improved stability. Reconstruction of the incus long process or incudostapedial joint defect with cement is preferred over partial ossicular reconstruction.
本研究的主要目的是分析羟基磷灰石骨水泥（HABC）听骨成形术的结果。这是一项对病例系列的回顾性研究。本研究在一家学术医院和三级转诊中心进行。共评估了127例使用HABC的听骨成形术。根据手术方式将耳朵分为三组：第1组包括用骨水泥加固砧镫关节并用骨水泥重建砧骨长突缺损。第2组包括用HABC进行镫骨与锤骨柄之间的部分听骨重建。第3组分为两个亚组。3B组采用可动足板重建镫骨（奥斯汀-卡图什B型=3B组），3F组采用固定足板重建镫骨（奥斯汀-卡图什F型=3F组），使用K-Helix活塞（美国田纳西州孟菲斯市格雷斯医疗公司）或经典钛活塞（德国富尔特市库尔兹公司）并用骨水泥粘于砧骨残端或锤骨柄。评估了解剖学及术前和术后的听力学结果。平均随访时间为26±14个月。术后平均气骨导间距≤20 dB的百分比分别为第1组95%、第2组82.5%、第3B组50%和第3F组83.3%，气骨导间距≤10 dB的百分比分别为第1组80%、第2组50.9%、第3B组16.6%和第3F组50%。未发生与骨水泥或挤出相关的并发症。听力结果也随时间保持稳定。根据我们的经验，骨水泥听骨成形术能提供良好且稳定的功能结果，安全、经济有效且易于使用。使用或不使用生物相容性听骨假体的HABC可修复不同类型的听骨缺损，同时保留听骨链的解剖和生理结构，并提高稳定性。用骨水泥重建砧骨长突或砧镫关节缺损优于部分听骨重建。
