摘要
目的探讨创伤性鼓膜穿孔不同临床时期创缘特征及干预方法。方法对伤后6h内接诊的494例创伤性鼓膜穿孔患者按创缘处理时间、穿孔大小行分组治疗。A组：伤后12h内处理的154例行残余鼓膜修复＋明胶海绵贴补治疗；B组：伤后12h后处理的149例行单纯明胶海绵贴补治疗；C组（116例）和D组（75例）均保守治疗。1个月后观察穿孔愈合情况。结果494例中，伤后6h内内镜检查结果显示，穿孔最大直径〉2．5mm的419例创伤性鼓膜穿孔患者中，349例（83．3％）穿孔缘残余鼓膜外翻，29例（6．9％）残余鼓膜内卷，41例（9．8％）破裂处鼓膜完全缺失。〈2．5mm的75例中，18例（24．0％）创缘残余鼓膜少许外翻，其余为创缘附近鼓膜皱折。伤后不同时间段A、B组在内镜下接受修复治疗：伤后6h内143例，7—11h11例，13—24h27例，25．5～48h59例，51～73h49例，75～192h14例，修复后穿孔最大直径缩小分别为（6．5±2．5）mm、（6．0±1．5）mm、（2．0±1．5）mm、（1．5±1．0）mm、（1．0±0．5）mm、0mm。随访1个月，A、B、C、D组穿孔愈合率分别为85．3％、71．2％、59．2％、81．4％，愈合时间分别为（10±4）d、（19±4）d、（25±2）d、（16±2）d。A组穿孔愈合率明显高于B组及C组（P〈0．05）；B组与C组及A组与D组穿孔愈合率比较，差异无统计学意义（P〉0．05）。结论创伤性鼓膜穿孔伤后早期并非是鼓膜的完全缺失，而是破裂鼓膜穿孔边缘外翻、内卷或鼓膜破碎等，这一现象随时问延长而不明显。伤后12h（特别是6h）内及时修复边缘翻折鼓膜可明显缩小穿孔直径，缩短穿孔愈合时间。
Objective To discuss wound edge characteristics at different clinical periods and intervention of traumatic perforation of tympanic membrane. Methods A total of 494 patients wth traumatic perforation of tympanic membrane were treated and grouped based on treatment time and size of perforation. Group A （n = 154, within 12 hours after injury） were treated by residual tympanic membrane repair and gelfoam. Group B （n = 149, 12 hours after injury） were treated by simple gelfoam. Group C （ n = 116 ） and Group D （ n = 75） were treated by conventional therapy. The wound healing of peroration was observed after one month. Results Of all, there were 419 patients with maximum perforation diameter 〉 2.5 mm within five hours after injury, of which 349 patients （83.3%） were with residual tympanic membrane valgus of perforation rim, 29 （6.9%）with involution of perforation rim and 41 （9.8%） with complete loss of tympanic membrane. Of 75 patients with maximum perforation diameter 〈 2.5 mm, residual valgus of perforation rim was found in 18 （24.0%） and tympanic membrane wrinkle near wound edge in the other patients. Under endoscopic repair of crimp tympanic membrane, maximum perforation diameter was reduced for （6.5 ± 2.5 ） mm in 143 patients at 6th hour, （6.0 ± 1.5 ） mm in 11 at 7-11 hours, （2.0±1.5） mm in27 at 13-24 hours,（1.5 ±1.0） mm in59 at 25.5-48 hours, （1.0 ± 0.5） mm in 49 at 51-73 hours and 0 mm in 14 at 75-192 hours. The follow up lasted for one month, which showed that healing rate of perforation in groups A, B, C and D were 85.3% , 71.2% , 59.2% and 81.4%, respectively. Healing time span was （10 ±4） days, （19±4） days, （：25 ±2） days and （16 ± 2） days, respectively. Conclusions Traumatic perforation of tympanic membrane is not complete tympanal deletion but residual tympanic membrane valgus of perforation rim, involution and tympanic membrane crushing, which shows insignificant change with time. In time repair of residual tympanic membrane
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2009年第3期209-212,共4页
Chinese Journal of Trauma
关键词
穿孔
鼓膜
创伤和损伤
干预
Perforation,tympanic membrane
Wounds and injuries
Intervention
