Maassen M M, Lüdtke R, Lehner R, Reischl G, Zenner H P
Universitäts-HNO-Klinik Tübingen.
HNO. 1997 Mar;45(3):133-9. doi: 10.1007/s001060050102.
Reliable methods of reconstruction of the ossicular chain in the situation of an isolated errosion of the long process of the incus using a tympanoplasty type II have not been available until recently. Instead, the tympanoplasty type III has been generally performed with the interposition of an autologous incus. In this presentation, we are describing two methods for reconstruction of the ossicular chain between the in-situ residing incus and the stapes on the other side so that the direct connection eventually will result in a tympanoplasty type II. In the first case, we used ionomeric cement in a way that features two characteristics: the direct connection between the stapes and the long process of the incus could be achieved as well as an articulation that was created on the head of the stapes. Hence, a too stiff connection between the head of the stapes and the long process of the incus could be avoided. In addition, a new method for precise microapplication of cooled bone cement (IONOCAP LV) with a syringe will be presented. In the second method titanium-gold-angle prostheses have been crimped to the long process of the incus and positioned onto the head of the stapes in the way of an articulation. So far, comparison of the audiological results of those two methods of a tympanoplasty type II reveal in average better results than postoperative conductive hearing thresholds of the conventional tympanoplasty type III. If the achieved results can be reproduced on a larger number of patients, the expected audiological results are likely to resemble those of stapes surgery.
直到最近，在砧骨长突孤立性侵蚀的情况下，采用II型鼓室成形术重建听骨链的可靠方法仍未出现。相反，III型鼓室成形术通常会植入自体砧骨。在本报告中，我们描述了两种在原位砧骨和另一侧镫骨之间重建听骨链的方法，最终直接连接将形成II型鼓室成形术。在第一个病例中，我们使用了具有两个特点的聚羧酸锌水门汀：既实现了镫骨与砧骨长突的直接连接，又在镫骨头处形成了关节连接。因此，可以避免镫骨头与砧骨长突之间连接过紧。此外，还将介绍一种使用注射器精确微量应用冷却骨水泥（IONOCAP LV）的新方法。在第二种方法中，钛金角形假体被压接在砧骨长突上，并以关节连接的方式放置在镫骨头上。到目前为止，对这两种II型鼓室成形术方法的听力学结果比较显示，平均而言，其结果优于传统III型鼓室成形术的术后传导性听力阈值。如果在更多患者身上能够重现所取得的结果，预期的听力学结果可能与镫骨手术的结果相似。
