鈦金屬和Hydroxyapatite材質的人工聽小骨用於聽小骨成形術之效果比較

Outcomes of Titanium versus Hydroxyapatite Prostheses in Ossiculoplasty

林建宏(Chien-Hung Lin) ； 黃彰暐(Chang-Wei Huang) ； 沈炳宏(Ping-Hung Shen) ； 賴仁淙(Jen-Tsung Lai)

《台灣耳鼻喉頭頸外科雜誌》 48卷2期 (2013/06) Pp. 164-170

https://doi.org/10.6286/2013.48.2.164

摘要

背景：人工聽小骨被用來重建聽小骨已有多年，但是少有研究將不同型態的疾病分開來比較鈦金屬和Hydroxyapatite材質的人工聽小骨，本研究主要在比較兩者之間的聽力結果和排出率。方法：本研究採回溯性研究方式，由同1名資深醫師以鈦金屬或Hydroxyapatite人工聽小骨進行聽小骨成形術。根據病患不同型態的疾病，分組為慢性中耳炎，膽脂瘤，非感染性傳導性聽力損失（包括先天性聽小骨異常以及外傷），以術後6個月聽力來分析比較，並追蹤其排出率。因非感染性傳導性聽力損失組以及TORP在各組的人數不多，分析比較的意義不大，僅統計其聽力改善狀況以及成功率。結果：共有152名被選入本研究當中，使用鈦金屬和Hydroxyapatite人工聽小骨的分別有78、74耳，氣骨導差間距（ΔABG）為術前氣骨導差（air-bone gap, ABG）減去術後氣骨導差。慢性中耳炎組中，部分聽小骨重建的ΔABG，鈦金屬為15.6 dB、Hydroxyapatite為12.5 dB。膽脂瘤組中，部分聽小骨重建的ΔABG，鈦金屬為5.5 dB、Hydroxyapatite為1.6 dB，全聽小骨重建的ΔABG，鈦金屬為11.7 dB、Hydroxyapatite為10.3 dB。非感染性傳導性聽力損失組中，部分聽小骨重建的ΔABG，鈦金屬為39.7 dB、Hydroxyapatite為23.8 dB，其中慢性中耳炎組和膽脂瘤組，比較部分聽小骨重建的Ti和HA的聽力結果均未達統計學上差異。聽小骨重建的Ti和HA的排出率皆為5%。結論：在短期的聽力追蹤下，Ti人工聽小骨在聽力結果的表現上略優於HA，但是無統計學上的差異，兩者的排出率也無統計學上的差異，而墊入軟骨能有效的預防人工聽小骨的排出。

關鍵字

人工聽小骨 ； 聽小骨成形手術 ； 鈦金屬

並列摘要

BACKGROUND: Ossicular replacement prosthesis has been used in ossicular chain reconstruction for years. Few studies compared Titanium (Ti) versus Hydroxyapatite (HA) prostheses according to different ear diseases. The aim of this study is to analyze the hearing results and extrusion rate between Titanium and Hydroxyapatite prostheses.METHODS: This is a retrospective study. Ossiculoplasty using either Titanium or Hydroxyapatite prostheses was performed by the same senior surgeon. According to different type of disease, patients were grouped into chronic otitis media, cholesteatoma, and non-infective conductive hearing loss (included congenital ossicular anomalies and trauma). We analyzed hearing results at 6 months postoperatively and follow up their extrusion rate.RESULTS: One hundred fifty-two patients were enrolled in this study. There were 78 patients using Titanium prostheses and 74 patients using Hydroxyapatite prostheses. The change in air-bone gap (ΔABG) defined as the difference between the means of preoperative and postoperative air-bone gap. For chronic otitis media group, the mean ΔABG in the patients with Ti partial ossicular replacement prosthesis(PORP) and the HA PORP were 15.6 and 12.5 dB, respectively. For cholesteatoma group, the mean ΔABG in the patients with Ti PORP and the HA PORP were 5.5 and 1.6 dB, the mean ΔABG in the patients with Ti total ossicular replacement prosthesis (TORP) and the HA TORP were 11.7 and 10.3 dB. For non-infective conductive hearing loss group, the mean ΔABG in the patients with Ti PORP and the HA PORP were 39.7 and 23.8 dB. There was no significant difference in hearing results between HA PORP and Ti PORP in cholesteatoma group as well as in chronic otitis media group. Statistic analysis was not performed between HA TORP and Ti TORP due to very small case number. The extrusion rate in both prostheses was all around 5%.CONCLUSIONS: In the short-term following-up, there were slightly better hearing results in Ti prostheses than HA prostheses, but no statistically difference between the two. There also was no significant difference in the extrusion rate between both prostheses. Cartilage interposition could prevent the extrusion of ossicular replacement prosthesis effectively.

並列關鍵字

ossicular replacement prosthesis ； ossiculoplasty ； titanium ； hydroxyapatite