摘要
目的：分析外伤性镫骨骨折患者的听力学特点、诊断要点和手术方法及疗效。方法回顾性分析解放军总医院耳鼻咽喉头颈外科1995年1月～2013年10月经鼓室探查术确诊的5例外伤性镫骨骨折患者的临床资料，根据术中所见采用不同材料行听骨链重建术，比较手术前后言语频率平均气导听阈及气骨导差，分析手术治疗效果。结果5例患者头部外伤后均表现为伤侧耳传导性聋，鼓膜完整，其中3例未引出同侧镫骨肌声反射，术中探查发现镫骨足弓骨折4例，镫骨颈骨折伴颞骨骨折、周围性面瘫1例。2例用自体砧骨、1例用异体砧骨、1例用外耳道前上棘骨片、1例用人工听骨（TORP）重建听骨链，伴面瘫者同时行面神经减压术。术后患者听力均明显提高，言语频率平均气导听阈由术前的61dBHL恢复至30．7dBHL（t＝6．725，P＜0．05），平均气骨导差由38．7dB缩小为18dB（t＝3．616，P＜0．05）。伴面瘫的患者面瘫等级由HBV级恢复至HBI级。结论镫骨骨折的主要表现为传导性聋，同侧镫骨肌声反射可能引出是特别值得注意的特征之一；通过鼓室探查，行听骨链重建术，可获得满意的听力恢复效果。
Objective To analyze the medical and audiological features of trauma induced stapes fracture ,and to summarize the key diagnostic points and to observe the effects of surgical treatment .Methods Five patients with trauma induced stapes fracture confirmed by the surgical exploration from January 1995 to October 2013 were retro_spectively reviewed .Ossicular chain reconstruction was performed on each patient .The preoperative and postopera_tive pure-tone thresholds were compared to judge the effects of surgical treatment .ResuIts The surgical explora_tion revealed 4 cases of stapes feet fracture ,1 case of stapes neck fracture with temporal bone fracture and peripheral paralysis of the facial nerve .Different types of ossicular reconstruction were performed according to the exploration results：2 cases with autogenous stapes remodeling ,1 case with allogenous stapes remodeling ,1 case with bone piece of external acoustic meatus ,and 1 case with artificial auditory ossicle（TORP） implanting .Additionally ,the case of peripheral paralysis of the facial nerve received facial nerve decompression .After the operation ,5 patients felt that their hearing was improved .The mean postoperative pure-tone threshold was 30 .7 dB HL ,and the mean ABG（air-bone-gap） was 18 dB HL while the mean preoperative pure-tone threshold was 61 dB HL（t=6 .725 ,P〈0 .05） and the mean ABG was 38 .7 dB HL（t=3 .616 ,P〈0 .05） .The facial nerve functions of the case with facial paralysis recovered to House-Brackmann Grade I three months after receiving facial nerve decompression .ConcIu_sion Stapes fractures are rare .Being different from the general conductive hearing loss ,patients with stapes fracture usu_ally have the acoustic stapedius reflex .Through ossicular reconstruction ,we can yield a satisfying hearing recovery .
出处
《听力学及言语疾病杂志》
CAS
CSCD
北大核心
2015年第1期25-28,共4页
Journal of Audiology and Speech Pathology
基金
国家自然科学基金面上项目(30973305
81170908)资助
关键词
外伤
镫骨骨折
听骨链重建
镫骨肌声反射
Trauma
Stapes fracture
Ossicular reconstruction
Acoustic stapedius reflex
作者简介
张纪帅，男，海南人，在读硕士研究生，主要研究方向为耳科学。
韩维举（Email：hanweiju@aliyun．com）
