Changes of incudostapedial joint angle in stapedotomy: does it impact hearing outcomes?
Changes of incudostapedial joint angle in stapedotomy: does it impact hearing outcomes?
复制标题
镫骨切开术中镫骨间关节角度的变化：是否会影响听力结果？
DOI：
10.1007/s00405-020-06103-7
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发表时间：
2020-06-10
影响因子：
2.6
通讯作者：
Chen, Bing
中科院分区：
文献类型：
--
作者：
Fang, Yanqing;Zhang, Kun;Chen, Bing
目的：（1）镫骨切开术后是否存在理想的砧镫关节角？(2)术前和术后ISJ角是否有差异？（3）ISJ角对术后听力的影响？方法回顾性登记了2017年5月至2019年5月期间接受镫骨切开术的39例不同成人临床耳硬化症患者的46耳（女性28例，男性11例;左耳21例，右耳25例），平均年龄39岁，其中包括7例双侧手术病例。通过多平面重建-计算机断层扫描图像测量镫骨假体的ISJ角和前庭内深度，并在手术过程中测量假体的长度。结果术前平均ISJ角为93.3° ± 8.8°，术后为101.9° ± 6.3°，镫骨切开术时增加8.6°（P< 0.01）。ISJ角变化与术后≤1 kHz的气导增益和0.5kHz的骨导增益呈弱负相关。当术后ISJ角变化大于20°时，手术成功率降至0%。术后听力结果的成功与ISJ角的变化有关，而不是角度本身的值，这表明在镫骨切开术中，外科医生应该瞄准的没有普遍理想的ISJ角。
PurposeThe aims of this article are: (1) is there an ideal incudostapedial joint (ISJ) angle after stapedotomy? (2) is there any difference between pre- and postoperative ISJ angle? and (3) what is the significance of the ISJ angle in postoperative hearing outcomes?MethodsForty six ears from 39 different adult patients (28 women and 11 men; 21 left and 25 right ears) with a mean age of 39 years with clinical otosclerosis who underwent stapedotomy between May 2017 and May 2019 were retrospectively registered, including seven bilateral surgery cases. ISJ angle and intravestibular depth of the stapes prosthesis were measured from multiple planar reconstruction-computed tomography images and the length of the prosthesis was measured during surgery. Relationships between the ISJ angle parameters and postoperative hearing outcomes and parameters of the prosthesis were analyzed.ResultsThe mean ISJ angle was 93.3° ± 8.8° preoperatively and 101.9° ± 6.3° postoperatively, increasing by 8.6° during stapedotomy (p< 0.01). There were weak and negative correlations between ISJ angle changes and postoperative air conduction gains at frequencies ≤1 kHz and bone conduction gains at 0.5 kHz. When the postoperative ISJ angle changed more than 20°, the success rate of the procedure decreased to 0%.ConclusionThe stapedotomy operation increased the ISJ angle. The success of postoperative auditory outcomes had more to do with the ISJ angle change than the value of the angle itself, indicating there is no universal ideal ISJ angle that surgeons should aim for during stapedotomy.