[1]张松志,宋　瑾,钟木生,等.软骨-颞肌筋膜复合物鼓室成形术修补鼓膜次全穿孔疗效观察[J].新乡医学院学报,2020,37(10):941-944.[doi:10.7683/xxyxyxb.2020.10.009]
　ZHANG Songzhi,SONG Jin,ZHONG Musheng,et al.Effect of cartilage-temporalis fascia composite tympanoplasty for subtotal tympanic membrane perforation[J].Journal of Xinxiang Medical University,2020,37(10):941-944.[doi:10.7683/xxyxyxb.2020.10.009]
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软骨-颞肌筋膜复合物鼓室成形术修补鼓膜次全穿孔疗效观察
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
37
期数:
2020年10
页码:
941-944
栏目:
临床研究
出版日期:
2020-10-05

文章信息/Info

Title:
Effect of cartilage-temporalis fascia composite tympanoplasty for subtotal tympanic membrane perforation
作者:
张松志; 宋　瑾; 钟木生; 张中华
（南方科技大学盐田医院耳鼻喉科，广东　深圳　518081）
Author(s):
ZHANG Songzhi; SONG Jin; ZHONG Musheng; ZHANG Zhonghua
(Department of Otolaryngology,Yantian Hospital,Southern University of Science and Technology,Shenzhen 518081,Guangdong Province,China)
关键词:
慢性中耳炎; 鼓膜穿孔; 鼓室成形术; 软骨; 软骨膜; 颞肌筋膜
Keywords:
chronic otitis media; tympanic membrane perforation; tympanoplasty; cartilage; perichondrium; temporalis fascia
分类号:
R764
DOI:
10.7683/xxyxyxb.2020.10.009
文献标志码:
A
摘要:
目的　探讨软骨-颞肌筋膜复合物鼓室成形术修补鼓膜次全穿孔的疗效。方法　选择2015年6月至2018年6月南方科技大学盐田医院收治的80例（80耳）慢性化脓性中耳炎伴鼓膜次全穿孔患者为研究对象，所有患者行鼓膜修补术，根据移植材料分为软骨-颞肌筋膜复合物组和颞肌筋膜组，每组40例（40耳）。所有患者术后随访6个月，术后3、6个月复诊时行鼓膜检查，观察鼓膜位置、活动度及是否穿孔和感染等；分别于术前和术后6个月进行纯音测听检查，测听检查均在同一隔声室由同一人操作。结果　软骨-颞肌筋膜复合物组患者术后1个月鼓膜活动差、稍厚，术后3个月鼓膜解剖形态基本正常，术后6个月40例患者鼓膜均愈合，鼓膜愈合率为100.0%（40/40）。颞肌筋膜组患者术后1个月鼓膜活动差，术后3个月鼓膜解剖形态基本正常，术后6个月时鼓膜愈合38例，鼓膜裂隙状穿孔2例，鼓膜愈合率为95.0%（38/40）。2组患者术后6个月鼓膜愈合率比较差异无统计学意义（χ2=2.051，P>0.05）。2组患者术前气骨导差比较差异无统计学意义（t=-0.645，P>0.05），2组患者术后6个月气骨导差均显著小于术前（t=15.173、13.684，P<0.05），2组患者术后6个月气骨导差比较差异无统计学意义（t=0.439，P>0.05）。结论　采用软骨-颞肌筋膜复合物鼓膜成形术修补鼓膜次全穿孔可获得较高的鼓膜愈合率和良好的听力效果；软骨-颞肌筋膜复合物既减小了移植物的质量，又强化了颞肌筋膜的韧性，二者联合使用是修补鼓膜大穿孔的另一选择。
Abstract:
Objective　To evaluate the effect of cartilage-temporalis fascia composite tympanoplasty for subtotal tympanic membrane perforation.Methods　Eighty patients (80 ears) with chronic suppurative otitis media complicated with subtotal tympanic membrane perforation admitted to the Yantian Hospital，Southern University of Science and Technology from June 2015 to June 2018 were selected as the study subjects.All patients underwent tympanoplasty and were divided into cartilage-temporalis fascia composite group and temporalis fascia group according to graft materials,with 40 patients (40 ears) in each group.All patients were followed up for 6 months after treatment.The position,activity,perforation and infection of the tympanic membrane were observed at 3 and 6 months after treatment.Pure tone audiometry was performed before and 6 months after operation.The audiometry was performed by the same person in the same sound-proof chamber.Results　In the cartilage-temporalis fascia composite group,the tympanic membrane activity was poor and slightly thicker at one month after surgery,the anatomical morphology of the tympanic membrane was basically normal at 3 months after surgery,the tympanic membrane healed in all 40 patients at 6 months after surgery,with a healing rate of 100.0% (40/40).In the temporalis fascia group,the patients had poor tympanic membrane activity at one month after surgery,and the anatomical morphology of the tympanic membrane was basically normal at 3 months after surgery,and 38 patients had tympanic membrane healing and 2 patients had tympanic membrane fissure perforation at 6 months after surgery,and the tympanic membrane healing rate was 95.0%(38/40).There was no significant difference between the two groups in the healing rate of eardrum at 6 months after operation (χ2=2.051,P>0.05).There was no statistically significant difference in the preoperative gas-bone gap between the two groups (t=-0.645,P>0.05).The a gas-bone gap at 6 months after operation was significantly lower than that before operation in the two groups (t=15.173,13.684；P<0.05).There was no statistically significant difference in the gas-bone gap between the two groups at 6 months after operation (t=0.439,P>0.05).Conclusion　Cartilage-temporalis fascia composite tympanoplasty for subtotal perforation of the tympanic membrane can obtain a higher healing rate and better hearing effect.The cartilage-temporalis fascia composite can reduce the mass of the graft and enhance the toughness of the temporalis fascia.The combination of the two is an alternative to repair the larger perforation of the tympanic membrane.

参考文献/References:

［1］　DERMIRPEHLIVAN I K,ONAL K,ARSLANOGLU S,et al.Comparison of different tympanic membrane reconstruction techniques in type I tympanoplasty［J］.Eur Arch Otorhinolaryngol,2011，268:471-474.
［2］　MURBE D,ZAHNERT T,BORNITZ M,et al.Acoustic properties of different cartilage reconstruction techniques of the tympanic membrane［J］.Laryngoscope,2002,112:1769-1776.
［3］　KAZIKDAS K C,ONAL K,BOYRAZ I,et al.Palisade cartilage tympanoplasty for management of subtotal perforations：a comparison with the temporalis fascia technique［J］.Eur Arch Otorhinolaryngol,2007,264:985-989.
［4］　AIDONIS I,ROBERTSON T C,SISMANIS A.Cartilage shield tympanoplasty：a reliable technique［J］.Otol Neurotol,2005,26(5):838-841.
［5］　TOS M.Cartilage tympanoplasty methods：proposal for a classification［J］.Otolaryngol Head Neck Surg,2008,139(6):747-758.
［6］　MOHAMAD S H,KHAN I,HUSSAIN S S.Is cartilage tympanoplasty more effective than facia tympanoplasty? A systematic review［J］.Otol Neurotol,2012,33(5):699-705.
［7］　YUNG M,VIVEKANANDAN S,SMITH P.Randomized study comparing fascia and cartilage grafts in myringoplasty［J］.Ann Otol Rhinol Laryngol,2011,120(8):535-541.
［8］　MAURI M,NETO J F,FICHS S C.Evaluation of inlay butterfly cartilage tympanoplasty：a randomised clinical trial［J］.Laryngoscope,2001,111(8):1479-1485.
［9］　CABRA J,MON~UX A.Efficacy of cartilage palisade tympanoplasty：randomized controlled trial［J］.Otol Neurotol,2010,31(4):589-595.
［10］　NEMADE S V,SHINDE K J,SAMPATE P B.Comparison between clinical and audiological results of tympanoplasty with double layer graft (modified sandwich fascia) technique and single layer graft (underlay fascia and underlay cartilage) technique［J］.Auris Nasus Larynx,2018,45(3)：440-446.
［11］　LEE C F,HSU L P,CHEN P R,et al.Biomechanica modeling and design optimization of cartilage myringoplasty using finite element analysis［J］.Audiol Neurotol,2006,11(6):380-388.
［12］　ZAHNERT T,HTTENBRINK K B,MRBE D,et al.Experimental investigations of the use of cartilage in tympanic membrane reconstruction［J］.Am J Otol,2000,21(3):322-328.
［13］　ZBAY C,SOY F K,KULDUK E,et al.Boomerang-shaped vs.shield-shaped chondroperichondrial cartilage grafts for type 1 tympanoplasty in children：a study of 121 patients［J］.Ear Nose Throat J,2017,96(10/11):419-432.
［14］　DEBASISH G,ARINDAM D,SAYAN H,et al.Maximising graft take-up in type1 tympanoplasty using peripheral cartilage ring and perichondrium［J］.Indian J Otolaryngol Head Neck Surg,2018,19 (2)：290-294.
［15］　刘雄光，姚立平，吴昌林，等.耳屏软骨环-软骨膜在鼓膜大穿孔修补的应用及影响其远期疗效相关因素分析［J］.中华耳科学杂志，2018，16（1）：54-60.
［16］　张松志，宋瑾，钟木生，等.U形软骨-软骨膜复合物在修补鼓膜大穿孔中的应用［J］.临床耳鼻咽喉头颈外科杂志，2016，30（14）：1139-1141
［17］　KULKARNI S,KULKARNI V,BURSE K,et al.Cartilage support for fascia graft in type Ⅰ tympanoplasty［J］.Indian J Otolaryngol Head Neck Surg,2014,66(3):291-296.
［18］　KOUHI A,TAGHI M,ASHTHIANI K,et al.Results of type I tympanoplasty using fascia with or without cartilage reinforcement：10 years′ experience［J］.Iran J Otorhinolaryngol,2018,30(97)：103-106.
［19］　KAYA I,TURHAL G,OZTURK A,et al.Results of endoscopic cartilage tympanoplasty procedure with limited tympanomeatal flap incision［J］.Acta Otolaryngol,2017,137(11)：1174-1177.
［20］　LYONS S A,SU T,VISSERS L E,et al.Fascia compared to one-piece composite cartilage perichondrium grafing for tympanoplasty［J］.Laryngoscope,2016,126(7):1662-1670.

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更新日期/Last Update: 2020-10-05