發(fā)布時間：2018-05-18 12:58

  本文選題：鼓室硬化 + 純音聽閾�。� 參考：《南方醫(yī)科大學(xué)》2013年碩士論文

【摘要】：研究背景 鼓室硬化(tympanosclerosis)多繼發(fā)于中耳粘膜慢性感染或炎癥,可發(fā)生于鼓室的任何部位,主要表現(xiàn)為進行性的傳導(dǎo)性耳聾。1869年Von Troltsch首先提出了“硬化(sclerosis)"一詞,并在1873年將其描述為中耳粘膜最深層纖維組織的硬化。過去常稱為鼓室硬化癥,現(xiàn)統(tǒng)稱為鼓室硬化。國外文獻報道人慢性化膿性中耳炎中鼓室硬化發(fā)病率為20%-43%,國內(nèi)報道為3.7%-11.7%。鼓室硬化的病因與發(fā)病機制目前尚未明了,術(shù)前診斷亦無明確標準,臨床上大多靠聽力學(xué)診斷,確診靠病理；鼓室硬化治療以手術(shù)為主,隨著耳顯微技術(shù)的應(yīng)用和鼓室成形術(shù)的廣泛開展,特別是人工聽骨贗復(fù)物、骨導(dǎo)助聽器、人工中耳的出現(xiàn),鼓室硬化的手術(shù)適應(yīng)癥不斷擴大、手術(shù)方式日益增多,但術(shù)式的選擇一直存在爭議,都是當前耳科學(xué)的難題。 臨床上常根據(jù)Wielinga和Kerr的分類方法,將鼓室硬化分為鼓膜硬化型、錘砧固定型、鐙骨固定型和全鼓室硬化型。其中鼓膜硬化型在術(shù)前可通過純音聽閡測定和耳內(nèi)鏡較容易診斷出來,但錘砧固定型、鐙骨固定型及全鼓室硬化型術(shù)前不易準確診斷。有學(xué)者對鼓室硬化的純音聽閾特點進行了分析,但不同分型的鼓室硬化純音聽閾特點報道極少。掌握不同分型的鼓室硬化純音聽閾特點,可為術(shù)前診斷及預(yù)后評估起著不可替代的作用。 聽骨鏈重建術(shù)是使鼓膜和外淋巴液之間恢復(fù)穩(wěn)定的傳聲連接,以達到恢復(fù)或改善中耳傳聲系統(tǒng)功能的手術(shù)。自20世紀50年代Wullstein和Zollner開展聽骨鏈重建術(shù)以來,耳科醫(yī)生為之進行了不少探索,取得了諸多進展,但對于鼓室硬化等聽骨存在病變的中耳炎病例的手術(shù)治療仍然是臨床中的難點,Eleftheriadou等報道,PORP聽骨鏈重建術(shù)后,隨訪14年,手術(shù)有效率僅為68.8%。許多學(xué)者從手術(shù)方式的選擇、人工聽骨材料的種類及術(shù)前病人的中耳情況等相關(guān)方面著手,研究影響鼓室硬化手術(shù)療效的因素,但始終沒有形成一個統(tǒng)一的意見,術(shù)中錘骨的處理對術(shù)后療效的影響更鮮有報道。 本研究通過回顧性分析鼓室硬化患者臨床資料,分析不同分型鼓室硬化患者術(shù)前的純音聽閾特點；探討聽骨鏈重建術(shù)中錘骨的3種不同處理方式對鼓室硬化患者療效的影響。為鼓室硬化的術(shù)前診斷、術(shù)式選擇及療效評估提供較好的理論參考。 第一部分鼓室硬化不同分型的純音聽閾特點分析 目的 探討不同分型的鼓室硬化患者純音聽閾測定特點,為術(shù)前診斷及預(yù)后評估提供理論參考。 方法 1.1臨床資料：對南方醫(yī)科大學(xué)珠江醫(yī)院2002年1月～2012年1月的1021份慢性化膿性中耳炎病案逐份詳細閱讀其入院及手術(shù)記錄。對納入本實驗研究的條件為：根據(jù)病史記錄、術(shù)中顯微鏡下探查及術(shù)后病理檢查診斷為鼓室硬化。本研究102例(102耳)資料完整的鼓室硬化病例中男40例,女62例,年齡12～60歲,平均34.15±11.26歲,病史最長50年,最短2年,平均17.97±10.13年。主要臨床表現(xiàn)為反復(fù)耳漏伴聽力下降,部分患者伴耳鳴。所有患者手術(shù)前干耳1個月以上。 1.2方法： 1.2.1實驗步驟：本研究102例患者術(shù)前1周內(nèi)行純音聽閾測定和耳內(nèi)鏡檢查。采用美國GSI61臨床聽力計和STORZ耳內(nèi)鏡進行檢測。各變量指標：測試250、500、1000、2000、4000Hz氣導(dǎo)(AC)和骨導(dǎo)(BC)聽閾(氣導(dǎo)上限：120dBHL,骨導(dǎo)上限：80dBHL,超出、未測出者定為缺失值)。500、1000和2000Hz的均值作為言語頻率平均純音聽閾(PTA)。氣骨導(dǎo)差(ABG)為同期言語頻率氣導(dǎo)閾值減去骨導(dǎo)閾值。觀察鼓膜一般情況。 1.2.2病灶分類：根據(jù)Wielinga和Kerr的分類方法結(jié)合術(shù)中顯微鏡下探查硬化灶的部位和范圍,將病例分成4型,Ⅰ型：鼓膜硬化型(24例),硬化灶累及鼓膜,聽骨鏈完整,活動好；Ⅱ型：錘砧骨固定型(30例),硬化灶累及上鼓室導(dǎo)致錘砧骨固定,鐙骨結(jié)構(gòu)完整,活動度好；Ⅲ型：鐙骨固定型(23例),上中鼓室硬化灶累及鐙骨導(dǎo)致鐙骨固定,錘砧關(guān)節(jié)完整,活動好；Ⅳ型：全鼓室硬化型(25例),鼓室內(nèi)硬化組織導(dǎo)致聽骨鏈包裹固定,部分聽骨破壞吸收伴或不伴鼓室腔膽脂瘤或肉芽形成。 1.2.3主要觀察指標：鼓膜硬化型、錘砧固定型、鐙骨固定型、全鼓室硬化型這四組病人言語頻率(500、1000、2000Hz)氣導(dǎo)聽閾(AC)、骨導(dǎo)聽閾(BC)及氣骨導(dǎo)差(ABG)值,鼓膜硬化型病例各頻率(250、500、1000、2000、4000Hz)氣導(dǎo)聽閾及骨導(dǎo)聽閾,錘砧固定型、鐙骨固定型、全鼓室硬化型這三組總的病例各頻率氣導(dǎo)聽閾及骨導(dǎo)聽閾。耳內(nèi)鏡檢查鼓膜穿孔及硬化灶分布情況。 1.2.4統(tǒng)計學(xué)處理：計量資料用均數(shù)±標準差(x±sdB HL)表示,四組均數(shù)的比較經(jīng)方差齊性檢驗后行方差分析(One-way ANOVA),組間均數(shù)的兩兩比較采用LSD檢驗。以p0.05為差異有統(tǒng)計學(xué)意義,所有統(tǒng)計分析采用SPSS13.0軟件完成。 結(jié)果 鼓室硬化Ⅰ型、Ⅱ型、Ⅲ型、Ⅳ型術(shù)前氣骨導(dǎo)差分別為25.97±4.42dB、37.83±6.95dB、39.64±5.43dB、39.2±7.42dB,其中Ⅰ型較其它三型氣骨導(dǎo)差小,差異有統(tǒng)計學(xué)意義(P0.05),其它三型之間的差異無統(tǒng)計學(xué)意義(P0.05),各型氣導(dǎo)曲線大致呈平坦型,Ⅱ型、Ⅲ型和Ⅳ型骨導(dǎo)曲線部分頻率下降。所有102例病例中,鼓膜完整3耳,穿孔99耳,47耳殘存鼓膜見硬化灶,74例為傳導(dǎo)性耳聾,28例為混合性耳聾,39例聽力圖出現(xiàn)Carchart切跡改變,除Ⅰ型之外的幾乎所有病例ABG30dB。 結(jié)論 鼓室硬化患者多呈傳導(dǎo)性耳聾,氣導(dǎo)表現(xiàn)為全部頻率受損,低頻略重于高頻,當ABG30dB時,可能預(yù)示著聽骨鏈病變；鼓室硬化Ⅱ型、Ⅲ型、Ⅳ型的聽力下降程度與硬化灶的范圍和程度無明顯關(guān)系。雖然我們不能通過術(shù)前純音聽閾特點確診鼓室硬化,但對于長期慢性化膿性中耳炎鼓膜穿孔者,純音聽閾測定顯示ABG30dB,要重點考慮鼓室硬化聽骨鏈固定或破壞的可能。 第二部分聽骨鏈重建術(shù)中錘骨的處理對鼓室硬化患者療效的影響 目的 探討鼓室硬化患者行聽骨鏈重建術(shù)中,錘骨的不同處理方式對術(shù)后療效的影響,為術(shù)式的選擇提供參考。 方法 1.1臨床資料：對南方醫(yī)科大學(xué)珠江醫(yī)院2002年1月～2012年1月的1021份慢性化膿性中耳炎病案逐份詳細閱讀其入院及手術(shù)記錄。對納入本實驗研究的條件為：1、根據(jù)術(shù)中顯微鏡下探查所見和術(shù)后病理檢查診斷為鼓室硬化；2、術(shù)中鐙骨上結(jié)構(gòu)固定、破壞或缺如,鐙骨完整,活動好；3、用多孔聚乙烯聽骨贗復(fù)物(Partial ossicular replacement prostheses, PORP)行聽骨鏈重建術(shù)。本研究59例(62耳)資料完整的鼓室硬化病例中男22例,女37例,年齡14～59歲,平均32.19±9.66歲,病史最長40年,最短5年,平均17.47±8.21年。所有患者手術(shù)前干耳1個月以上。術(shù)后隨訪15-21個月,平均16.1月。 1.2方法： 1.2.1實驗步驟：回顧性分析59例(62耳)經(jīng)聽骨鏈重建術(shù)的鼓室硬化錘砧固定型病例資料,按術(shù)中對錘骨的處理方式不同,分為去除錘骨組(24耳),僅保留錘骨柄組(18耳)和完整保留錘骨組(20耳)。分析3組患者術(shù)前、術(shù)后3個月、術(shù)后1年的言語頻率平均純音聽閾,計算氣骨導(dǎo)差及氣骨導(dǎo)差改善值,并用耳內(nèi)鏡觀察鼓膜移植物存活情況,比較3種錘骨處理方式對療效的影響。 1.2.2手術(shù)方法：18歲以下患者采用全身麻醉,其余均為局部浸潤麻醉,取患者仰臥位,頭偏向?qū)?cè),術(shù)耳向上,所有患者均采用耳內(nèi)切口,在距鼓環(huán)6-8mm平面作外耳道皮瓣,分離皮瓣,挑起鼓環(huán)進入鼓室,術(shù)中鑿開上鼓室,探查聽骨鏈,清除錘骨、砧骨周圍硬化灶,分離錘砧和砧鐙關(guān)節(jié),將砧骨取出,對錘骨的處理有去除錘骨、剪掉錘骨頭僅保留錘骨柄和完整保留錘骨,然后用部分人工聽骨PORP橋接錘骨柄和鐙骨頭,或橋接鼓膜和鐙骨頭,兩者之間嵌以一薄層耳屏軟骨。對于合并鼓膜硬化者,術(shù)中清除鼓環(huán)或錘骨柄周圍影響鼓膜運動的鼓膜硬化斑,鼓膜其它部位硬化斑超過鼓膜面積1/3的予以清除,用顳肌筋膜按內(nèi)置法行鼓膜成形術(shù)。明膠海綿和碘仿紗條填塞術(shù)腔,術(shù)部加壓包扎2-3天,2周后取出外耳道填塞物。 1.2.3數(shù)據(jù)收集及主要觀察指標：所有病例均在術(shù)前1周內(nèi)行純音聽閾測定和耳內(nèi)鏡檢查,并收集術(shù)后3月及術(shù)后1年的純音聽閾測定、耳內(nèi)鏡資料。測量工具：采用美國GSI61臨床聽力計和STORZ耳內(nèi)鏡進行檢測。各變量指標：記錄500、1000、2000Hz氣導(dǎo)閾值和骨導(dǎo)閾值(氣導(dǎo)上限：120dBHL,骨導(dǎo)上限：80dBHL,超出、未測出者定為缺失值)。氣骨導(dǎo)差(ABG)為同期言語頻率氣導(dǎo)閾值減去骨導(dǎo)閾值,氣骨導(dǎo)差改善值為術(shù)前氣骨導(dǎo)差減去術(shù)后氣骨導(dǎo)差；觀察術(shù)后鼓膜移植物生長情況。1.2.4統(tǒng)計學(xué)處理：計量資料用均數(shù)±標準差(x±s dB HL)表示,手術(shù)前后均數(shù)的比較采用配對樣本t檢驗,三組間均數(shù)的比較經(jīng)方差齊性檢驗后行方差分析(One-way ANOVA),組間均數(shù)的兩兩比較采用LSD檢驗。以p0.05為差異有統(tǒng)計學(xué)意義,所有統(tǒng)計分析采用SPSS13.0軟件完成。 結(jié)果 去除錘骨組、僅保留錘骨柄組、完整保留錘骨組術(shù)前氣骨導(dǎo)差分別為40.07±7.56dB、37.31±6.45dB、36.75±6.72dB,三組之間的差異無統(tǒng)計學(xué)意義(p0.05),術(shù)后3個月3組病例平均氣骨導(dǎo)差較術(shù)前分別縮小18.15±8.64dB、17.69±6.65dB、18.17±8.39dB,差異無統(tǒng)計學(xué)意義(F=0.092,p0.05)。術(shù)后1年,氣骨導(dǎo)差較術(shù)前分別縮小17.92±9.28dB、16.76±5.19dB、10.58±7.38dB,其中完整保留錘骨組氣骨導(dǎo)差縮小程度明顯小于去除錘骨組和僅保留錘骨柄組(p0.05),而去除錘骨組和僅保留錘骨柄組氣骨導(dǎo)差縮小的差異無統(tǒng)計學(xué)顯著性(p0.05)。術(shù)后1年,去除錘骨組和僅保留錘骨柄組各1例鼓膜穿孔人工聽骨脫落,其余鼓膜完整,少有塌陷。結(jié)論 聽骨鏈重建術(shù)中錘骨的不同處理方式對鼓室硬化患者短期療效無顯著影響；長期療效方面,完整去除錘骨和僅保留錘骨柄效果相當,均顯著優(yōu)于完整保留錘骨。
[Abstract]:Research background
Tympanosclerosis (tympanosclerosis) is secondary to chronic infection or inflammation of the middle ear mucosa, which can occur at any part of the tympanum, mainly as progressive deafness.1869 Von Troltsch first proposed the word "sclerosis", and in 1873 it was described as the sclerosis of the deepest fibrous tissue of the middle ear mucosa. For tympanosclerosis, it is known as tympanosclerosis. The incidence of tympanosclerosis in chronic suppurative otitis media in foreign literature is 20%-43%. It is reported that the etiology and pathogenesis of 3.7%-11.7%. tympanosclerosis is not clear at home, and there is no clear standard for preoperative diagnosis. Most of them depend on the diagnosis of hearing and pathology; tympanic cavity is hard. With the application of surgery and the extensive development of ear microtechnology and tympanoplasty, especially artificial auditory osseous prostheses, bone guided hearing aids, artificial middle ear, tympanosclerosis, surgical indications are constantly expanding, and surgical methods are increasing. However, the selection of surgical methods has been controversial, which are the problems of the current otology.
According to the classification of Wielinga and Kerr, tympanic sclerosis is divided into tympanic sclerosis type, hammer anvil fixed type, stapes fixation type and total tympanosclerosis type. The tympanosclerosis can be easily diagnosed by pure tone audiometry and ear endoscopy before operation, but the hammer anvil fixation, stapes fixation and total tympanosclerosis are not easy before operation. Accurate diagnosis. Some scholars have analyzed the characteristics of the pure tone hearing threshold of the tympanosclerosis, but there are few reports on the characteristics of the different types of tympanosclerosis pure tone threshold.
The reconstruction of auditory ossicle chain is to restore a stable sound connection between the tympanic membrane and the lymph, in order to recover or improve the function of the sound system of the middle ear. Since the reconstruction of the ossicular chain was carried out in Wullstein and Zollner in 1950s, many explorations have been made by the ear doctors, and many progress have been made, but the auditory ossicles, such as tympanosclerosis, have been taken. Surgical treatment of cases of otitis media with pathological changes is still a difficult problem in clinical. Eleftheriadou and other reports, after the PORP ossicular chain reconstruction, 14 years of follow-up, the operation efficiency is only 68.8%. many scholars from the selection of surgical methods, the types of artificial ossicular materials and the situation of the middle ear of the patients before the operation, and study the influence of the tympanum hard. However, there has never been a unified view on the effect of surgical treatment, and the effect of operative malleus on the postoperative outcome is rarely reported.
Through a retrospective analysis of the clinical data of tympanosclerosis patients, the characteristics of pure tone hearing threshold in different types of tympanic sclerosis patients were analyzed, and the effects of 3 different treatments of the malleus on the effect of tympanosclerosis in the reconstruction of the ossicular chain were discussed. On the reference.
Part one characteristics of pure tone audiometry in different types of tympanosclerosis
objective
Objective to investigate the characteristics of pure tone audiometry in patients with different types of tympanosclerosis, and to provide theoretical reference for preoperative diagnosis and prognosis evaluation.
Method
1.1 clinical data: 1021 cases of chronic suppurative otitis media in Zhujiang Hospital of Southern Medical University from January 2002 to January 2012 were read through their admission and surgical records in detail. The conditions included in this study were: according to the records of the disease, the diagnosis of the tympanosclerosis by microscopy under microscope and postoperative pathophysiological examination was 102 cases of this study. (102 ears) of the complete cases of tympanosclerosis, there were 40 males and 62 females, with an average age of 12~60 years and an average of 34.15 + 11.26 years old. The duration of the disease was 50 years, the shortest, 2 years, and the average of 17.97 + 10.13 years. The main clinical manifestations were recurrent ear leakage with hearing loss and some patients with tinnitus. All the patients were above the dry ear for more than 1 months.
The 1.2 method:
1.2.1 experimental steps: 102 patients in this study were performed pure tone audiometry and ear endoscopy within 1 weeks before operation. The American GSI61 clinical audiometer and STORZ ear endoscopy were used to test the variables: the test of 250500100020004000Hz gas conductance (AC) and bone conduction (BC) hearing threshold (the upper limit of air conductivity: 120dBHL, bone conduction upper limit: 80dBHL, excess, and undetected) The mean value of.5001000 and 2000Hz is regarded as the average tone threshold of speech frequency (PTA). The bone conductance (ABG) subtracts the threshold of bone conduction from the air conduction threshold of the speech frequency at the same time.
1.2.2 focus classification: according to the classification of Wielinga and Kerr combined with microscopic examination of the site and scope of the sclerotic focus under microscope, the cases were divided into 4 types, type I: tympanosclerosis (24 cases), the hardened foci involving the tympanic membrane, the complete ossicular chain and good activity; type II: the hammer anvil fixed (30 cases), and the sclerotic focal involvement of the tympanum leading to the hammer incus fixation. The stapes had a complete structure and good activity; type III: stapes fixation (23 cases). The upper and middle tympanosclerosis was involved in stapes to cause stapes to be fixed, the hammer anvil was complete, and the activity was good; type IV: total tympanosclerosis (25 cases), the sclerosis tissue in the tympanum resulting in the ossicular chain fixation, partial ossicular destruction absorbed with or without tympanic cavity cholesteatoma or granulation. It is.
1.2.3 main observation indexes: tympanosclerosis type, hammer anvil fixed type, stapes fixation type, total tympanosclerosis type four groups of patients' speech frequency (50010002000Hz) air conduction hearing threshold (AC), bone conduction hearing threshold (BC) and air bone conductance (ABG) value, each frequency (250500100020004000Hz) air conduction hearing threshold and bone conduction threshold, hammer anvil fixed type, stapes The three groups were fixed type and total tympanosclerosis. The frequencies of gas conduction audiometry and bone conduction audiometry were examined by ear endoscopy.
1.2.4 statistical treatment: the measurement data were expressed with mean mean + standard deviation (x + sdB HL). The four groups were compared with the square deviation homogeneity test (One-way ANOVA), and the 22 of the average number of groups was compared to LSD test. The difference was statistically significant with P0.05, and all statistical analysis was completed by SPSS13.0 software.
Result
The preoperation of tympanosclerosis type I, type II, type III and IV was 25.97 4.42dB, 37.83 + 6.95dB, 39.64 + 5.43dB, 39.2 + 7.42dB, of which type I was smaller than other three types of gas, and the difference was statistically significant (P0.05). The difference between the other three types was not statistically significant (P0.05), and the gas conductance curves were roughly flat, type II and III type In all 102 cases, all 102 cases had complete 3 ears of tympanic membrane, 99 ears perforated, 47 ears with residual tympanic membrane, 74 cases of conductive deafness, 28 cases of mixed deafness, and 39 hearing maps with Carchart notch change, almost all cases ABG30dB. except type I.
conclusion
The patients with tympanosclerosis are mostly conductive deafness, the air conduction is all frequency impaired and the low frequency is slightly heavier than the high frequency. When ABG30dB, it may indicate the lesion of the ossicular chain. The degree of hearing loss of the tympanosclerosis type II, type III and type IV is not significantly related to the scope and extent of the hardened focus. Although we can not diagnose the drum by the preoperatively pure tone hearing threshold Ventricular sclerosis, but for chronic suppurative otitis media with tympanic membrane perforation, the pure tone audiometry shows ABG30dB, which should focus on the possibility of the fixation or destruction of the tympanic ossicle chain.
The effect of the second part of the ossicular chain reconstruction on the curative effect of tympanosclerosis patients
objective
Objective to explore the effect of different ways of malleus on postoperative outcome of ossicular chain reconstruction in patients with tympanosclerosis.
Method
1.1 clinical data: 1021 cases of chronic suppurative otitis media in Zhujiang Hospital of Southern Medical University from January 2002 to January 2012 were read through their admission and surgical records in detail. The conditions included in the study were 1, the diagnosis of tympanosclerosis by microscopic examination and postoperative pathological examination; 2, the stapes during the operation. The structure was fixed, damaged or absent, the stapes was complete and the activity was good; 3, the ossicular chain reconstruction was performed with Partial ossicular replacement prostheses (PORP). In this study, 59 cases of tympanic sclerosis (62 ears) with complete data of the tympanosclerosis were male, 37 cases, 14~59 years old and 32.19 + 9.66 years, with the longest history of 40 years, and the shortest 5. 5 The average age was 17.47 + 8.21 years. All patients had dry ears for more than 1 months before operation. The average follow-up period was 16.1 months after 15-21 months.
The 1.2 method:
1.2.1 experimental steps: retrospective analysis of 59 cases (62 ears) of the tympanosclerosis hammer anvil of the ossicular chain reconstruction, divided into the malleus group (24 ears), only the malleus handle group (18 ears) and the intact malleus group (20 ears). The speech frequency of the 3 groups was analyzed before the operation, 3 months after operation and 1 years after the operation. The average pure tone hearing threshold was used to calculate the improvement of bone conductivity and bone conduction difference. The survival of the tympanic membrane grafts was observed by ear endoscopy, and the effect of 3 kinds of malleus treatment on the curative effect was compared.
1.2.2 operation method: the patients under 18 years of age were anesthetized with general anesthesia, the rest were local infiltration anaesthesia, the patients were taken on the supine position, the head partial to the opposite side, the ear was upward, all the patients were used in the ear incision, the outer ear flap was used as the flap from the drum ring 6-8mm plane, the flap was separated, the drum was picked up into the drum chamber, the tympanic chamber was cut open, the ossicular chain was explored, the malleus scavenged and the malleus was scavenged. The hardened area around the anvil, the anvil and the incus stapes joint were removed, the anvil was removed, the malleus was removed, the hammer bone was removed and the malleus was retained and the malleus was retained, then the malleus and the stapes were bridged with a part of the artificial ossicular PORP, or the tympanic membrane and stapes were bridged with a thin layer of cartilage. In the case of membrane sclerosis, the tympanic membrane plaque that affects the tympanic membrane movement around the drum or the malleus handle is cleared during the operation. The sclerotic plaque of the other parts of the tympanic membrane is cleared over the area of the tympanic membrane 1/3. The tympanoplasty is performed by the built-in method of the temporalis myofascial. The gelatin sponge and iodoform gauze are filled in the cavity, the operation is packed for 2-3 days, and the external auditory canal filling is removed after 2 weeks.
1.2.3 data collection and main observation indicators: all cases were performed pure tone audiometry and ear endoscopy within 1 weeks before operation, and the pure tone audiometry of March and 1 years postoperatively was collected, and the ear endoscopy data. Measurement tools: the American GSI61 clinical audiometer and STORZ ear endoscopy were used. The variables: record 50010002000Hz Air conductivity threshold and bone conduction threshold (upper limit of air conductivity: 120dBHL, upper limit of bone Guide: 80dBHL, exceeding, undetected person as missing value). Air bone conductance (ABG) subtracts bone conduction threshold at the same period of speech frequency gas conduction threshold, and the improvement value of air bone conductance is reduced by bone conduction difference after operation, and the growth of tympanic membrane grafts after operation is observed by.1.2.4 statistics Study treatment: the measurement data were represented by mean number + standard deviation (x + s dB HL). The comparison of the average number between the three groups before and after the operation was compared with the t test of paired samples. The average number of all groups was compared with the variance analysis (One-way ANOVA), and the 22 of the average number of groups was compared with LSD test. The statistical significance of P0.05 was statistically significant. All statistical analysis adopted S. PSS13.0 software is completed.
Result
The malleus group was removed, only the malleus shank was retained. The bone conduction difference was 40.07 7.56dB, 37.31 6.45dB and 36.75 6.72dB before the malleus group. The difference between the three groups was not statistically significant (P0.05). The average gas conductivity of the 3 groups in the 3 months after the operation was 18.15 + 8.64dB, 17.69 + 6.65dB, 18.17 + 8.39dB, respectively, and the difference was not statistically significant. Significance (F=0.092, P0.05). 1 years after operation, the air bone conductivity narrowed by 17.92 + 9.28dB, 16.76 + 5.19dB and 10.58 + 7.38dB respectively. The reduction degree of the gas bone conductivity in the complete malleus group was significantly smaller than that of the malleus group and only the malleus handle group (P0.05), but the difference between the malleus group and the malleus handle group was not statistically significant. Significance (P0.05). In 1 years after operation, 1 cases of tympanic membrane perforation were removed from the malleus group and only the hammer handle group.
The different treatments of ossicular chain reconstruction had no significant effect on the short-term effect of tympanosclerosis patients.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R764.29

【參考文獻】

相關(guān)期刊論文 前8條

1 萬良財;謝南屏;嚴星;陳國強;;生物陶瓷人工聽骨在鼓室硬化手術(shù)中應(yīng)用的療效分析[J];南方醫(yī)科大學(xué)學(xué)報;2006年04期

2 李琰;謝南屏;萬良財;;鼓室注射金黃色葡萄球菌致豚鼠鼓室硬化模型的建立[J];南方醫(yī)科大學(xué)學(xué)報;2007年11期

3 楊玲;鼓室硬化癥的術(shù)后聽力判定及分析[J];國外醫(yī)學(xué).耳鼻咽喉科學(xué)分冊;2002年03期

4 童軍;陳文文;鄧亞新;蔡勛華;;鼓室硬化的手術(shù)療效觀察[J];臨床耳鼻咽喉科雜志;2006年16期

5 萬良財;郭夢和;謝南屏;劉雙秀;陳浩;龔劍;陳帥君;;鼓室硬化患者中耳黏膜及硬化灶組織病理學(xué)特點[J];聽力學(xué)及言語疾病雜志;2009年04期

6 鄒堅定;熊華;;咽鼓管功能對鼓室成形術(shù)療效的影響[J];中國眼耳鼻喉科雜志;2010年01期

7 楊仕明,劉清明,黃德亮,韓東一,楊偉炎;鐙骨手術(shù)治療鼓室硬化癥遠期療效觀察[J];中華耳鼻咽喉頭頸外科雜志;2005年03期

8 楊仕明;宇雅蘋;韓東一;;人工聽骨在鼓室成形術(shù)中的應(yīng)用[J];中華耳科學(xué)雜志;2007年02期

，

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