Dornhoffer J L
Department of Otolaryngology--Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock 72205, USA.
Laryngoscope. 1998 Apr;108(4 Pt 1):531-6. doi: 10.1097/00005537-199804000-00013.
The "ideal" prosthesis for ossicular reconstruction should, from a surgical standpoint, require easy manipulation, reduce surgeries to partial or total variants, and be constructed of stable, biocompatible material. From an acoustic standpoint, a prosthesis should weigh 10 to 40 mg, provide proper tension between the tympanic membrane (TM) and stapes, form less than a 30-degree angle with the TM, and accommodate the malleus. Work was conducted with Smith & Nephew Richards, Inc. (Memphis, TN), to develop a partial ossicular replacement prosthesis (PORP) and a total ossicular replacement prosthesis (TORP) that combined the majority of these features. This retrospective study used a computerized otologic database to identify patients implanted with a Dornhoffer HAPEX PORP or TORP from June 1995 to March 1997. The surgical procedures utilizing these prostheses were primary cholesteatoma and revision surgery of previously performed modified or radical mastoidectomies complicated by poor hearing or chronically draining cavities. Preoperative and postoperative air and bone conduction four-frequency (500, 1000, 2000, and 3000 Hz) pure-tone averages (PTAs) were used to calculate the PTA air-bone gaps (ABGs). Results in 52 cases (follow-up, 1 year) showed a statistically significant improvement in hearing (P < 0.05) for each group. Excellent hearing results (< or = 10 dB PTA-ABG) were seen in 69% of PORP cases and in 35% of TORP cases, and good results (11 to 20 dB PTA-ABG) were seen in 31% and 50% of PORP and TORP cases, respectively. Designing an ossicular replacement prosthesis with both surgical and acoustic factors in mind has led to encouraging short-term hearing results.
从手术角度来看，用于听骨链重建的“理想”假体应易于操作，减少手术至部分或全部变体，并由稳定的生物相容性材料制成。从声学角度来看，假体应重10至40毫克，在鼓膜（TM）和镫骨之间提供适当的张力，与TM形成小于30度的角度，并适配锤骨。与史赛克理查兹公司（田纳西州孟菲斯）合作开展了相关工作，以开发一种结合了这些主要特征的部分听骨置换假体（PORP）和全听骨置换假体（TORP）。这项回顾性研究使用计算机化耳科数据库，确定1995年6月至1997年3月间植入多恩霍弗HAPEX PORP或TORP的患者。使用这些假体的手术包括原发性胆脂瘤以及先前进行的改良或根治性乳突切除术的翻修手术，这些手术因听力不佳或长期引流腔而变得复杂。术前和术后的气导和骨导四频率（500、1000、2000和3000赫兹）纯音平均值（PTA）用于计算PTA气骨间隙（ABG）。52例患者（随访1年）的结果显示，每组听力均有统计学意义的改善（P < 0.05）。在PORP病例中，69%的患者听力结果极佳（PTA - ABG≤10分贝），在TORP病例中为35%；在PORP和TORP病例中，分别有31%和50%的患者听力结果良好（PTA - ABG为11至20分贝）。在设计听骨置换假体时兼顾手术和声学因素，已带来了令人鼓舞的短期听力结果。
