Lamba Ghatdeep K, Sohal Barjinder Singh, Goyal Jagdish Prasad
1Department of ENT, GMC Patiala, 385 Chhoti baradari Part 1, Jalandhar, Punjab 144001 India.
2Department of ENT, GMC Patiala, 68, Mansahia Colony, Patiala, 147001 India.
Indian J Otolaryngol Head Neck Surg. 2019 Nov;71(Suppl 2):1140-1146. doi: 10.1007/s12070-018-01571-0. Epub 2019 Jan 3.
With large number of grafts available for ossiculoplasty, choice becomes difficult. An ideal graft should be safe, easily available, cost efficient, with good hearing results, uptake and low extrusion rates. The ear nose and throat surgeon is still facing the indecision over type of graft to be selected. A prospective study was conducted in Department of Otorhinolaryngology, Rajindra Hospital, Patiala (August 2012-2014) on 50 patients 15-60 years, of either sex with ABG > 40 dB. Operative procedure planned and type of graft decided intraoperatively. Autografts included remodelled malleus, remodelled incus and tragal cartilage grafts. Synthetic (Teflon) grafts were PORP and TORP. Graft uptake/failure was noted at 1 and 3 months. PTA done at 3 months postoperatively. Net hearing gain (change in ABG) was calculated for various grafts used and analysed. Mean age was 35.26 ± 13 yrs, male and female 1:1. Most common involved ossicle was incus (100%) followed by stapes (36%) and malleus (34%). Autografts, 23, uptake in 20 (86.95%), failure 3 (13.04%) cases. Synthetic grafts, 27, uptake 18 (66.66%) and failure 9 (33.33%). 'p'value 0.09 (non significant). Mean hearing gain, autografts 14.47 ± 6.54 dB and synthetic grafts 14.57 ± 13.12 dB. 'p' value 0.976 (non significant). No significant difference seen in mean hearing gain and uptake/failure of autografts and synthetic grafts. Autografts being cost effective are preferred choice.
由于有大量移植物可用于听骨成形术，选择变得困难。理想的移植物应安全、易于获取、成本效益高、听力效果好、吸收率高且挤出率低。耳鼻喉科医生仍在为选择何种移植物而犹豫不决。2012年8月至2014年，在帕蒂亚拉市拉金德拉医院耳鼻喉科对50例年龄在15至60岁、两性ABG＞40dB的患者进行了一项前瞻性研究。术中规划手术步骤并确定移植物类型。自体移植物包括重塑的锤骨、重塑的砧骨和耳屏软骨移植物。合成（聚四氟乙烯）移植物为部分听骨赝复物（PORP）和全听骨赝复物（TORP）。在1个月和3个月时记录移植物的吸收/失败情况。术后3个月进行纯音听阈（PTA）检查。计算并分析了所使用的各种移植物的净听力增益（ABG变化）。平均年龄为35.26±13岁，男女比例为1:1。最常受累的听小骨是砧骨（100%），其次是镫骨（36%）和锤骨（34%）。自体移植物23例，20例（86.95%）吸收，3例（13.04%）失败。合成移植物27例，18例（66.66%）吸收，9例（33.33%）失败。“p”值为0.09（无统计学意义）。平均听力增益，自体移植物为14.47±6.54dB，合成移植物为14.57±13.12dB。“p”值为0.976（无统计学意义）。自体移植物和合成移植物在平均听力增益及吸收/失败方面未见显著差异。自体移植物具有成本效益，是首选。
