人工耳蜗植入术中自体乳突皮质骨重建乳突腔骨质缺损

Using Autologous Mastoid Cortical Bone during Cochlear Implantation

刘丛利;孙家强;侯晓燕;陈建文;孙敬武;

1:安徽医科大学附属安徽省立医院耳鼻咽喉头颈外科

摘要
目的探讨在成人人工耳蜗植入术中,应用自体乳突区皮质骨回放覆盖乳突切开后骨质缺损的临床效果。方法以58例行人工耳蜗植入的成人极重度感音神经性聋患者为研究对象(修复组),术中均采用切除的自体乳突区皮质骨片回放重建乳突切开后骨缺损的手术方式,术后观察患者耳后伤口痊愈情况、有无并发症;于术后1月开机时及术后3、6月检测助听听阈,并与同期未行自体乳突皮质骨重建乳突腔骨质缺损的同类患者(对照组)比较。结果修复组术后无一例出现耳后皮肤凹陷,均没有发生创面感染、急慢性中耳炎及颅内并发症,回放的皮质骨片愈合良好;术后复查所有患者耳蜗植入体无移位,术后1月开机时患者的平均助听听阈较术前提高约70dB(P<0.05),术后1、3、6月平均助听听阈与对照组差异无统计学意义(均为P>0.05),效果良好。结论在成人人工耳蜗植入手术中,应用自体乳突区皮质骨重建乳突腔皮质骨缺损能够避免耳后的凹陷,保证乳突的通气,有利于植入体的稳定性,且术后助听效果良好。
关键词
人工耳蜗植入;乳突区皮质骨;乳突区缺损
基金项目(Foundation):
作者
刘丛利;孙家强;侯晓燕;陈建文;孙敬武;
参考文献

1 Roberts DM,Bush ML,Jones RO.Adult progressive sensorineural hearing loss:is preoperative imaging necessary before cochlear implantation?[J].Otol Neurotol,2014,35:241.

2 Brand Y,Senn P,Kompiset M,et al.Cochlear implantation in children and adults in Switzerland[J].Swiss Med Wkly,2014,144:w13909.

3 Hausler R.Cochlear implantation without mastoidectomy:the pericanal electrode insertion technique[J].Acta Otolaryngol,2002,122:715.

4 Hansen S,Anthonsen K,Stangerup SE,et al.Unexpected findings and surgical complications in 505consecutive cochlear implantations:aproposal for reporting consensus[J].Acta Otolaryngol,2010,130:540.

5 Jung TT,Park SK.Reconstruction of mastoidectomy defect with titanium mesh[J].Acta Otolaryngol,2004,124:440.

6 Yanagihara N,Hinohira Y,Sato H.Mastoid cortex plasty using bone pate[J].Otol Neurotol,2002,23:422.

7 Minoda R,Yanagihara N,Hinohira Y,et al.Efficacy of mastoid cortex plasty for middle ear aeration in intact canal wall tympanoplasty for cholesteatoma[J].Otol Neurotol,2002,23:425.

8 Hellingman CA,Dunnebier EA.Cochlear implantation in patients with acute or chronic middle ear infectious disease:a review of the literature[J].Eur Arch Otorhinolaryngol,2009,266:171.

9 Donnelly MJ,Pyman BC,Clark GM.Chronic middle ear disease and cochlear implantation[J].Ann Otol Rhinol Laryngol,1995,166(Suppl):406.

10 Yuen HW,Thompson AL,Symons SP,et al.Vascularized mastoid bone flap cranioplasty after translabyrinthine vestibular schwannoma surgery[J].Skull Base,2009,19:193.

11 Kim HH,Wilson DF.Titanium mesh for functional reconstruction of the mastoid cortex after mastoidectomy[J].Otol Neurotol,2006,27:33.

12 Yu ZL,Yang BT,Wang ZC,et al.Reconstruction of lateral attic wall using autogenous mastoid cortical bone[J].American Journal of Otolaryngology,2011,32:361.