Surgical Repair of Bone Defects of the Ear Canal Wall with Flexible Hydroxylapatite Sheets: A Pilot Study
Surgical Repair of Bone Defects of the Ear Canal Wall with Flexible Hydroxylapatite Sheets: A Pilot Study
复制标题
用柔性羟基磷灰石片手术修复耳道壁骨缺损：初步研究
作者：
D. Zanetti;N. Nassif;A. Antonelli
目的评价羟基磷灰石和聚合物柔性复合片在鼓室成形术中外耳道成形术中的适用性。研究设计前瞻性、开放标签先导性研究。设置大学和地区医院。在1996-1997年间收治的356例患者中，随机选择42例慢性中耳炎(n=20)和胆脂瘤(n=22)患者。干预措施通过部分或全部乳突根治术根治疾病；立即用柔性复合板(羟基磷灰石和聚合物)和结缔组织移植重建管壁。结果测量OEC和新鼓室的解剖完整性、排出率、并发症。结果术后至少随访24个月：胆脂瘤复发0例，中鼓室胆脂瘤残留3例(13.6%)，无一例位于羟基磷灰石膜后、上鼓室或上鼓室。新鼓室完好者38耳(90.4%)，再穿孔2耳，严重内陷、偏侧化各1耳。42例患者中37例(88%)OEC解剖完整，5耳观察到狭窄或膜性粘连，在办公室接受治疗。7例(16.6%)患者因化脓性耳漏和肉芽组织形成而发生羟基磷灰石片状脱出。手术翻修33耳(78.6%)，重建的管壁完全上皮化。结论采用上述手术技术治疗的患者中，超过四分之三的患者有望在术后2年内获得干燥、无病的耳朵和正常的解剖结构。结缔组织移植物的完全保护对于避免植入物挤压是必不可少的。如果手术时有耳漏，失败率明显较高。
Objective Evaluation of suitability of flexible composite sheets (hydroxylapatite and polymer) for outer ear canal (OEC) wall reconstruction in tympanoplasty. Study Design Prospective, open label pilot study. Setting University and regional hospital. Patients Forty-two randomly selected patients with chronic otitis media (n = 20) and cholesteatoma (n = 22) among 356 patients admitted between 1996 and 1997. Interventions Eradication of disease through a partial or total canal wall down mastoidectomy; immediate reconstruction of canal wall with flexible composite sheet (hydroxylapatite and polymer) and connective tissue graft. Outcome Measures Anatomic integrity of the OEC and neotympanum, extrusion rate, complications. Results At minimum follow-up of 24 months: recurrent cholesteatoma (n = 0), residual cholesteatoma (n = 3/22) (13.6%) in the mesotympanum (none behind the hydroxylapatite sheet or in the attic or antrum). The neotympanum was intact in 38 ears (90.4%), reperforated in 2, and severely retracted and lateralized in 1, respectively. Anatomic integrity of the OEC was obtained in 37 (88%) of 42 patients; stenosis or membranous synechiae were observed in 5 ears and treated in the office. Extrusion of the hydroxylapatite sheet occurred in 7 patients (16.6%) because of purulent otorrhea and granulation tissue formation. Surgical revision achieved complete epithelialization of the rebuilt canal wall in 33 ears (78.6%). Conclusions A dry, disease-free ear and normal anatomy may be expected 2 years postoperatively in more than three-fourths of the patients treated using the described surgical technique. Complete protection with a connective tissue graft is essential to avoid extrusion of the implant. The failure rate is significantly higher if otorrhea is present at the time of the operation.
噪声和奎宁对血管纹血管的影响：图像分析研究。
影响因子：
2.5
作者：
Smith,DI;Lawrence,M;HawkinsJr,JE
通讯作者：
HawkinsJr,JE