耳硬化症的微创镫骨手术：降低术后眩晕风险。
Minimally traumatic stapes surgery for otosclerosis: Risk reduction of post-operative vertigo.
机构信息
Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Otolaryngology, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Otolaryngology, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Department of Otolaryngology, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan, ROC; Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
出版信息
J Chin Med Assoc. 2018 Jun;81(6):559-564. doi: 10.1016/j.jcma.2017.08.022. Epub 2018 Feb 7.
BACKGROUND
The author (Dr. Shiao) modified traditional stapes surgery (TSS) specifically for patients with otosclerosis. The proposed technique, referred to as minimally traumatic stapes surgery (MTSS), reduces the risk of subjective discomfort (i.e. vertigo and tinnitus) following surgery. This paper compares the effectiveness of MTSS with that of TSS.
METHODS
The medical records of patients with otosclerosis after stapes surgery (TSS or MTSS) were analyzed. Outcome variables included post-operative vertigo, tinnitus, and hearing success. Multivariate logistic regression analysis was used to determine the correlation between surgical technique and outcome variables.
RESULTS
TSS was performed in 23 otosclerosis ears and MTSS was performed in 33 otosclerosis ears. The risk of post-operative vertigo was significantly lower among patients that underwent MTSS (27%) than among those that underwent TSS (83%, p < 0.001). No differences in the incidence of tinnitus were observed between the two groups. Post-operative audiometric outcomes were also equivalent between the two groups. However, multivariate logistic regression analysis revealed a correlation between post-operative vertigo and surgical technique (p < 0.001).
CONCLUSION
MTSS involves a lower risk of vertigo than does TSS. MTSS helps to prevent damage to the footplate, thereby reducing the risk of footplate floating. Therefore, MTSS provides a means to overcome some of the limitations associated with the narrow surgical field in Asian patients.
背景
作者（肖医生）专门针对耳硬化症患者对传统镫骨手术（TSS）进行了改良。所提出的技术称为微创镫骨手术（MTSS），可降低术后主观不适（即眩晕和耳鸣）的风险。本文比较了 MTSS 与 TSS 的效果。
方法
分析了接受镫骨手术（TSS 或 MTSS）治疗的耳硬化症患者的病历。主要的观察指标包括术后眩晕、耳鸣和听力成功。采用多变量逻辑回归分析确定手术技术与观察指标之间的相关性。
结果
23 耳接受了 TSS，33 耳接受了 MTSS。MTSS 术后发生眩晕的风险明显低于 TSS（27%比 83%，p<0.001）。两组患者耳鸣的发生率无差异。两组患者术后听力结果也相当。但是，多变量逻辑回归分析显示，术后眩晕与手术技术之间存在相关性（p<0.001）。
结论
MTSS 引起眩晕的风险低于 TSS。MTSS 有助于防止镫骨底板受损，从而降低底板漂浮的风险。因此，MTSS 提供了一种克服亚洲患者手术视野狭窄相关局限性的手段。
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