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首页> 外文期刊>European Archives of Oto-Rhino-Laryngology >Osteoplastic atticoantrotomy with autologous bone chips and a bony attic strut in cholesteatoma surgery
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Osteoplastic atticoantrotomy with autologous bone chips and a bony attic strut in cholesteatoma surgery

机译：胆脂瘤手术中自体骨碎屑和骨性骨质支持物的骨肿瘤性骨瓣切除术

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The objectives of this study were to determine whether autologous bone chips are suitable materials for canal wall reconstruction after cholesteatoma removal and to evaluate the effectiveness of a separate attic bone graft for the prevention or recurrent cholesteatomas using prospective study of two consecutive patient series (29/31 unselected patients with an average follow-up of 36.3 ± 11.1/21.5 ± 6.3 months) and retrograde resection of the posterior-superior canal wall followed by reconstruction of the canal defect using one or more temporal squama bone chips. In the second series, lateral attic wall reconstruction and pars flaccida reinforcement was established by a notched bony attic strut attached onto the neck and short process of the malleus for structural support. In the first series, the rate of recurrent cholesteatomas (17.3%), in particular of attic retraction pockets (31%), was significantly high. The average postoperative air–bone gap was 6.4 ± 6.3 dB in type-I tympanoplasty (TP), 8.7 ± 3.4 dB in type-III TP with intact stapes suprastructure, and 16.4 ± 9.3 dB in type-III TP with TORP, respectively. In the second series, recurrent cholesteatoma and retraction pocket rate could be decreased to 9.7 and 6.5%, respectively. The postoperative air–bone gap was 7.5 ± 5.1 dB HL in type-I tympanoplasty (TP), 11.6 ± 4.9 dB HL in type-III (PORP) TP, and 17.9 ± 12.2 dB HL in type-III (TORP) TP. Connecting the attic strut to the malleus neck did not affect the malleus mobility and hearing outcome. Osteoplastic atticoantrotomy with autologous bone chip reconstruction enables a tailor-made anatomical and physiological reconstitution of the auditory ear canal, thus enhancing the acoustic properties. Precise reconstruction of the lateral attic wall and reinforcement of the superior part of the tympanic membrane seems to be important for the prevention of retraction pockets and subsequent recurrent cholesteatoma development.
机译：这项研究的目的是确定自体骨碎屑是否适合胆脂瘤切除后的管壁重建，并使用前两个连续患者系列的前瞻性研究评估单独的阁楼骨移植物预防或复发性胆脂瘤的有效性（29 / 31例未选择的患者，平均随访36.3±11.1 / 21.5±6.3个月），逆行切除后上管壁，然后使用一个或多个颞鳞骨碎屑重建管缺损。在第二个系列中，通过附接到颈部的带凹口的骨质阁楼支撑杆和短短的锤骨过程为结构支撑，建立了外侧阁楼壁重建和pars flaccida加固。在第一个系列中，复发性胆脂瘤的发生率（17.3％），尤其是阁楼缩回袋的复发率（31％）非常高。 I型鼓室成形术（TP）的平均术后气隙为6.4±6.3 dB，具有骨上ra结构的III型TP的平均术后气隙分别为8.7±3.4 dB，带TORP的III型TP的平均术后气隙为16.4±9.3 dB。在第二系列中，复发性胆脂瘤和缩回率可分别降低至9.7和6.5％。 Ⅰ型鼓室成形术（TP）的术后气骨间隙为7.5±5.1 dB HL，Ⅲ型（PORP）TP的术后气管间隙为11.6±4.9 dB HL，Ⅲ型（TORP）TP的为17.9±12.2 dB HL。将阁楼撑杆连接到踝骨颈部不会影响踝骨的活动性和听力结果。具有自体骨芯片重建的整骨瓣膜切开术可实现听觉耳道的量身定制的解剖和生理重建，从而增强了声学特性。精确重建阁楼外侧壁和加强鼓膜上部对于预防缩回袋和随后复发性胆脂瘤发展似乎很重要。

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