虚拟耳镜对外伤性听骨链中断手术前后的评估作用

目的 探讨虚拟耳镜对鼓膜完整的外伤性听骨链中断手术前后的评估作用.方法采用高分辨螺旋CT轴位、斜冠状位颞骨扫描,应用虚拟耳镜软件,对选取的17例颞骨骨折患者和4例鼓膜钝挫伤患者进行图像三维重建.10例砧骨脱位或脱落经完壁式上鼓室进路听骨复位术;11例砧骨长脚断裂或脱位伴面神经麻痹则行听骨链成形术和面神经减压术.有9例患者术后复查虚拟耳镜.结果 17例颞骨骨折外伤性听骨链中断,其中砧骨长脚断裂3例,砧骨脱位9例,砧骨脱落5例;4例鼓膜钝挫伤砧骨脱位2例,砧骨脱落2例.颞骨CT显示骨折线和锤砧骨不规整.虚拟耳镜清楚显示锤砧关节与砧镫关节脱位,砧骨脱落或骨折,可见砧骨长脚与镫骨分离,砧骨体移位.手术证实,砧骨体脱出向后移位并有软组织包裹,砧骨长脚与镫骨之间软组织相连或分离.鼓膜顿挫伤术中见砧骨脱落呈外翻状.手术后3～6个月复查,虚拟耳镜见砧骨脱位者听骨链恢复接近正常,砧骨脱落者听骨连接完整.术后患耳听力明显提高达实用听力水平.外伤性听骨链中断的虚拟耳镜观察与手术证实符合率为100%.结论 虚拟耳镜为准确评估外伤性听骨链中断,确立个体化手术方案和术后随访提供可靠的直观依据.

Evaluation of the virtual endoscopy on traumatic ossicular chain disruption pre- and post-operation

OBJECTIVE: To evaluate the clinical use of virtual endoscopy in the traumatic ossicular chain disruption with intact tympanum pre- and post-operation. METHODS: The seriesconsisted of 17 cases with temporal bone fracture and 4 cases with tympanum contusion. All were examinated with a high resolution spiral CT by axial and oblique coronal planes of the temporal bone. Three-dimensional reconstruction was processed using the virtual endoscopy software. Ten cases of traumatic ossicular chain disruption were performed with intact canal wall epitypanum approach Ossicular reposition. Eleven patients with facial paralysis were performed ossiculoplasty and facial nerve decompression. Nine cases re-examinated virtual endoscopy after operation. RESULTS: Seventeen cases with temporal bone fractures and traumatic ossicular chain disruption, including 3 cases with the long process of the incus fracture, 9 cases with incus bone dislocation, and 5 cases with incus shedding. In the 4 cases of tympanum contusion, 2 cases with incus bone dislocation, 2 cases with incus bone shedding. The axial plane of temporal bone CT could only showed the fracture line and the hammer and incus bone irregular shape. Perioperatively virtual endoscopy showed hammer incus joint separation, incus stirrup dislocation and joint deformation. Surgery confirmed that the incus body was torn off below the hammer following bone displacement, soft tissue wrapped articular surface, incus and stapes just connected with soft tissue. During the tympanum contusion operation could see incus bone-shedding was valgus. Three to six months after surgery, re-examinated virtual endoscopy showed incus bone dislocation ossicular chain was restored to normal, temporal bone shedding ossicular chain connecting almost intact Hearing increased significantly to the level of practical hearing. The coincidence of traumatic disruption of the ossicular chain by virtual endoscopy and surgery was 100%. CONCLUSION: Virtual endoscopy was valuable for providing accurate assessment and individual program for treating and following-up the traumatic ossicular chain disruption.