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Objective:To evaluate the therapeutic effects of epitympanum approach tympanotomy in treating traumatic ossicular chain disruption.
目的:评估完壁式上鼓室进路鼓室探查术治疗外伤性听骨链中断的临床疗效。方法:10例颞骨骨折和耳外伤而鼓膜完整的患者,颞骨CT轴位示锤砧关节不规整,冠状位示砧镫关节不连续。
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Results:① The distance between handle of malleus and stapes head was(2.38±0.19)cm(2.00~2.70cm), the point selecting for measuring was outer margin of handle of malleus and stpes head.②The cross section form of one_third of the handle of malleus at the end, was triangle, the anteroposterior diameter of handle of malleus was(0.79±0.12)mm, the exterior and interior diameter was(0.58±0.10)mm at the crook point,the angle of line of manubrium mallei laid(83.24±8.33)°(66~98°)posteroinferior to arch of zygoma.③The long axis of prosthesis formed(27.60±1.75)°(24.6~30.2°)angle with the perpendicular of stapes.④The dependablity between the malleus_stapes distance and transverse diameter of tympanum, the location of umbo in tympanic membrane, the diameter of manubrium mallei, angle of line of manubrium mallei and arch of zygoma were not statistically significant.
结果:①锤_镫距离最短为(2.38±0.19)cm(2.00~2.70cm),测量点为锤骨柄末端1/3处外缘和镫骨头;②锤骨柄末段1/3横断面形状接近三角形,弯曲处前、后方向直径为(0.79±0.12)mm,内、外方向直径为(0.58±0.10)mm;锤骨柄与颞线的成角为(83.24±8.33)°(66~98°);③赝复物长轴与镫骨垂直方向成角平均为(27.60±1.75)°(24.6~30.2°);④锤_镫距离与鼓室横径、鼓脐在鼓膜上的位置、锤骨柄直径、锤骨柄的方位的可能相关因素之间相关性检验无统计学意义。
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Methods Twenty-two pieces of temporal bone were taken for this study. The mastoid cavity was opened, scutum removed,"bridge" broken down, posterior wall of external auditory canal abraded and the related anatomic structures were fully exposed. The distance between the origin of facial nerve canal and the anterior border of round window ( OOFNC-ABORW ), between the highest point of the facial nerve canal and the bottom of posterior mastoid sinus,and between the stapes head and round window niche was measured under operating microscope.
方法取成人颞骨22侧(左右各11侧),用耳科钻磨开乳突腔,去上鼓室盾板、断"桥",磨低骨性外耳道后壁,充分暴露相关结构,在手术显微镜下测量面神经管垂直段起始部前缘至圆窗龛前缘的距离、面神经管最高点与后鼓室底壁之间的距离、锥隆起的高度(即锥隆起基底到锥隆起顶端的距离)、镫骨头至圆窗龛前缘的距离。
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Results Of 355 ears in 200 children with secretory otitis media, 240 ears exhibited type B tympanogram and 115 ears type C. Removal of hydrotympanum was performed in 355 ears. There was no significant difference in total obtaining liquid rate (P>0.05). However, there was very significant differences in obtaining mucus rate, stapedius muscle reflex and recurrence rate (P<0.01), and a significant difference in obtaining serous rate (P<0.05). There was no misdiagnosis and missed diagnosis in 200 sick children undergoing acoustic immitance determination.
结果 200例(355耳)分泌性中耳炎患儿呈B型鼓室导抗图240耳,C型鼓室导抗图115耳,分别对其抽出鼓室积液,它们的总得液率无显著性差异(P>0.05),但其得粘液率、镫骨肌反射、复发率有极显著性意义(P<0.01),得浆液率有显著性意义(P<0.05);在接受200例声导抗检查的患儿中,无1例发生误诊及漏诊。
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Methods Twenty-two pieces of temporal bone were taken for this study. The mastoid cavity was opened, scutum removed,"bridge" broken down, posterior wall of external auditory canal abraded and the related anatomic structures were fully exposed. The distance between the origin of facial nerve canal and the anterior border of round window ( OOFNC-ABORW ), between the highest point of the facial nerve canal and the bottom of posterior mastoid sinus,and between the stapes head and round window niche was measured under operating microscope.
方法取成人颞骨22侧(左右各11侧),用耳科钻磨开乳突腔,去上鼓室盾板、断&桥&,磨低骨性外耳道后壁,充分暴露相关结构,在手术显微镜下测量面神经管垂直段起始部前缘至圆窗龛前缘的距离、面神经管最高点与后鼓室底壁之间的距离、锥隆起的高度(即锥隆起基底到锥隆起顶端的距离)、镫骨头至圆窗龛前缘的距离。
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columella auris:耳柱骨
因为呈马镫状而有此名. 在镫骨的底部紧贴内耳的前庭窗,在其对侧以镫骨小头与砧骨之间形成砧镫关节(incudostapedial articulation). 另外在小头上从鼓室壁起始的镫骨肌终止于此. 镫骨与蜴形类的耳柱骨(columella auris)相同,来源于鱼类的舌颚骨.
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stapedial nerve:镫骨肌神经
2.镫骨肌神经 镫骨肌神经(stapedial nerve)自锥隆起后方由面神经分出一支,经锥隆起内之小管到镫骨肌. 3.鼓索神经 鼓索神经(chorda tympani nerve)从镫骨肌神经以下到茎乳孔之间的面神经任一部位分出,经一单独骨管进入并穿过鼓室,
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tympanostapedial:鼓室镫骨的
tympanosquamousfissure 鼓鳞裂 | tympanostapedial 鼓室镫骨的 | tympanosympathectomy 鼓室丛切除术 鼓室交感神经切除术