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上半规管裂术后结果:156 例修复的病例系列。

Superior semicircular canal dehiscence postoperative outcomes: A case series of 156 repairs.

机构信息

Department of Neurosurgery, Ronald Reagan UCLA Medical Center, Los Angeles, CA, United States.

Department of Head and Neck Surgery, Ronald Reagan UCLA Medical Center, Los Angeles, CA, United States.

出版信息

J Clin Neurosci. 2019 Oct;68:69-72. doi: 10.1016/j.jocn.2019.07.053. Epub 2019 Aug 2.

Abstract

Previous studies have looked at differences in predisposing factors, symptomology, treatment options, and outcomes in patients with SSCD experiencing audiologic and vestibular symptoms, however this study utilizes data from the largest series of SSCD patients by a single pair of neurosurgeon and head and neck surgeon to date. The objective was to determine what pre-operative factors, if any, contribute to post-operative outcomes in SSCD patients. A retrospective chart review collected patient demographics, preoperative symptoms, and postoperative symptoms. Nonparametric tests were run using IBM® SPSS® Statistics. Fisher's Exact Tests, Spearman's rho, and McNemar's test for paired comparison of binary measures were performed, with a significance level of P < 0.05. A total of 156 SSCD surgeries were performed within a cohort of 119 patients. The majority of patients were female (n = 75, 63.0%). The median age was 55 years (±12.7 years) and median follow-up length was 0.46 months (range: 0.03-59.5 months). Increased postoperative dizziness and hearing loss was significantly correlated with females (P = .048, P = .041). Additionally, males reported significantly improved postoperative hearing (P = .044) with confirmatory audiometry. Serum ionized calcium levels inversely correlated with age using spearman's coefficient (r = -.260 P = .037). Postsurgical autophony was significantly associated with bilateral SSCD (P = .01). In conclusion, differences in outcomes between patients may have to do with bilateralism of SSCD or gender effects. Proposed theories concerning a "two hit" hypothesis and about calcium feedback regulation in SSCD may play a role in these findings. Understanding differences between symptomology will help facilitate discussions with future patients.

摘要

先前的研究已经探讨了 SSCD 患者出现听觉和前庭症状时,易患因素、症状、治疗选择和结果的差异,但本研究利用了由同一位神经外科医生和头颈外科医生对迄今为止最大的 SSCD 患者系列数据。目的是确定任何术前因素是否有助于 SSCD 患者的术后结果。回顾性图表审查收集了患者的人口统计学资料、术前症状和术后症状。使用 IBM® SPSS® Statistics 运行非参数检验。进行了 Fisher's Exact Tests、Spearman's rho 和 McNemar's 检验,用于二进制测量的配对比较,显著性水平为 P < 0.05。在 119 名患者的队列中进行了 156 例 SSCD 手术。大多数患者为女性(n = 75,63.0%)。中位年龄为 55 岁(±12.7 岁),中位随访时间为 0.46 个月(范围:0.03-59.5 个月)。术后头晕和听力损失增加与女性显著相关(P = .048,P = .041)。此外,男性报告术后听力显著改善(P = .044),并通过确认听力图证实。血清离子钙水平与年龄呈负相关,使用斯皮尔曼系数(r = -.260 P = .037)。术后自体发声与双侧 SSCD 显著相关(P = .01)。总之,患者之间的结果差异可能与 SSCD 的双侧性或性别效应有关。关于“双打击”假说和 SSCD 中钙反馈调节的理论可能在这些发现中起作用。了解症状之间的差异将有助于与未来的患者进行讨论。

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