摘要
背景:人工电子耳蜗是用来代替病变耳蜗的一种高科技治疗手段,影像学检查可以帮助了解人工耳蜗电极的植入情况。目的:探讨CT及X射线检查对人工电子耳蜗植入术前患者筛选及术后效果评估的价值。设计:自身前后对照观察。单位:南方医科大学附属珠江医院耳鼻咽喉科听力重建病房。对象:选择1999-01/2003-06拟进行人工耳蜗植入术的重度或极重度感音性耳聋患者44例。语前耳聋32例,年龄2.5～12岁;语后耳聋12例,年龄10～42岁。方法:对44例患者均采用颞骨轴位高分辨率CT螺旋扫描及内耳三维重建。患者取仰卧位,两侧对称分别做靶扫描,视野9.6cm,基线与听眶上线平行,轴位容积扫描颞骨。扫描参数:层厚1mm,螺距1.0,间距0.5mm,扫描结束后再行层厚1mm,间距0.1mm内插重建。术后采用常规耳蜗轴位改良的斯氏位X射线摄影,对于怀疑有术后并发症的3例患者,行螺旋CT颞骨容积扫描。主要观察指标:①术前患者内耳结构检查结果。②术后患者内耳和植入电极排列及深度检查结果。结果:按意向处理分析,44例患者均进入结果分析。①术前患者内耳结构检查结果:32例语前聋患者中检出1例2耳Mondini畸形Ⅰ型,2例4耳Mondini畸形Ⅱ型;12例语后聋患者中检出2例4耳慢性化脓性中耳炎,1例2耳内耳骨化,1例2耳耳硬化症,3例6耳大前庭水管综合征。②术后患者内耳和植入电极排列及深度检查结果:X射线片显示,植入的耳蜗电极位于耳蜗之中,呈二维的螺旋状,位于内耳道底。3例术后行CT检查,电极自圆窗植入耳蜗底周。其中1例术后植入电极扭结并感染。结论:①人工耳蜗植入患者术前应用颞骨轴位高分辨率CT螺旋扫描及内耳三维重建可以检出急慢性中耳炎、内耳骨迷路结构的严重畸形。②术后耳蜗位X射摄影片可提供电极的位置、植入的深度以及电极有无扭结或滑脱。CT及耳蜗位摄片检查相互补充,可进行术前病例选择和术后效果评估,有助于最大限度地发挥人工耳蜗改善听力的作用。
BACKGROUND： Artificial electronic cochlear （AEC） is a high-tech product used as a therapeutie substitute for pathological cochlear, and the implantative state of AEC can be assessed with the aid of imaging techniques. OBJECTIVE： To investigate the significance of CT and X-ray examination in the evaluation of preoperative seleetion and postoperative therapeutic result of patients with AEC implantation. DESIGN： Self-eontrol observaton. SETTING：Auditory Rebuilding Ward of Otolaryngology Department, Zhujiang Hospital, Southern Medical University. PARTICIPANTS：Forty-four patients prepared for AEC implantation because of severe sensorineural hearing loss or extremely severer sensorineural hearing loss were recruited from the Otolaryngological Department, Zhujiang Hospital, Southern Medical University from January 1999 to June 2003. Thirty-two patients were with prespeeeh hearing loss, aged 2.5-12 and 12 patients with postspeeeh hearing loss, aged 1042. METHODS： Axial high-resolution temporal bone CT and three-dimensional reconstruction of inner ear were performed on 44 patients. They lay in supine position and reeeived bilateral symmetric scanning with view of 9.6 cm. The baseline was set at the level of upper limit of auditory frame, and temporal hone was axially seanned. The scanning parameters were：thickness of 1 mm, spiral distanee of 1.0 and interval of 0.5 mm; inserting rebuilding was performed after scanning with thickness of 1mm and interval of 0.1 mm. The improved routine cochlear axial stenves-X-ray image was performed after operation, and three patients underwent spiral CT temporal volume scanning due to suspicious postoperative complications. MAIN OUTCOME MEASURES：① Preoperative inner ear structure. ②Postoperative inner ear and the arrangement and depth of implanted AEC. RESULTS： Totally 44 patients were remained in the result analysis performed according to intention-to-treat analysis.① Preoperative inner ear structure： Of the 32 patients with prespeech deafness, 1 case （2 ears） was diagnosed as type ⅠMondini malformation and 2 cases （4 ears） as type Ⅱ Mondini malformation . Of the 12 patients with postspeeeh deafness, chronie suppurative otitis meadia was observed in 2 cases （4 ears ） , inner ear ossification in lease （2 ears ）, large vestibular aqueduet syndrome in 3 cases（6 ears） and cochlear sclerosis in 1 ease （2 ears）. ②Postoperative inner car and the arrangement and depth of implanted AEC：image of X-ray indicated that the electrode was implanted right in cochlea,displaying planar spiral shape and located at the bottom of inner-ear channel. Postoperative CT scanning was performed on 3 eases and revealed that electron was implanted into the bottom surroundings through round window and the electrode got twisted and infected in one cases. CONCLUSION：①Axial high-resolution temporal bone CT scanning and three-dimensional rceonstnletion of inner car can be adopted before AEC implantation for screening out acute and chronic suppurative and severe otitis meadia, server maformation of inner car labyrinth.②Postoperative Xray image ean afford clues to know the position and depth of implanted AEC and find out the twist and olithy of electrode, if any CT and cochlea image are supplemented for preoperative case selection and postoperative therapeutie cvaluatinn, helping AEC to exert auditory function to the maximual degree.
出处
《中国临床康复》
CSCD
北大核心
2005年第30期222-223,共2页
Chinese Journal of Clinical Rehabilitation
