背景:骨锚式听力植入物(BAHI)被认为是用于传导性和混合性听力损失,依靠钛植入物的骨整合。局限性与不断的皮肤接触有关,导致经皮感染和肉芽。本研究调查了采用统一手术方法的患者特征和植入物规格是否会导致BAHIs皮肤并发症。
方法:对BAHI程序进行了一项为期10年(2014-2024年)的回顾性队列研究,该程序使用组织保存“打孔”技术进行。患者人口统计数据,合并症,植入物类型,手术方法,收集并发症。使用泊松回归分析来确定并发症的预测因子。
结果:共有53例患者接受了由3名耳鼻喉科顾问进行的55例BAHI手术。与Ponto™BHX植入物相比,大大增加植入物相关经皮感染的因素包括Cochlear™BIA400植入物(两倍,CI2.03-2.16),基台尺寸≤10mm(四倍,CI3.99-4.12)和男性(9%,CI1.07-1.12)。肉芽发作受心血管疾病(CVD)状态的影响(1.5倍,CI0.26-0.78),BIA400植入物(三倍,CI8.8.-9.2)和桥台尺寸≤10mm(四倍,CI3.6-3.73)。修订手术发作随糖尿病状态而增加(1.2倍,CI0.06-0.37)和基台尺寸≤10mm(三倍,3.303-3.304)。
结论:需要更大规模的队列研究来确认发现,特别是对于植入物和基台尺寸的贡献。然而,研究结果表明,当皮肤厚度测量是边界时,使用更大的基台尺寸,改善男性患者的卫生教育,术前优化CVD和糖尿病,根据并发症发生率影响因素的危险分层调整患者随访可降低并发症发生率.
BACKGROUND: Bone anchored hearing implants (BAHI) are considered for conductive and mixed hearing loss, relying on osseointegration of a titanium implant. Limitations relate to constant skin contact, with resultant percutaneous infections and granulation. This study investigates whether patient characteristics and implant-specifications contribute to BAHIs\' skin complications in a cohort with a uniform surgical approach.
METHODS: A 10 year (2014-2024) retrospective cohort study was conducted on BAHI procedures that were undertaken using a tissue-preserving \'punch\' technique. Data on patient demographics, co-morbidities, implant type, surgical approach, and complications were collected. Poisson regression analysis was used to identify predictors of complications.
RESULTS: A total of 53 patients undergoing 55 BAHI surgeries by three ENT consultants were included. Factors that greatly increased implant-related percutaneous infections included the Cochlear™ BIA400 implant when compared to the Ponto™ BHX implant (twofold, CI 2.03-2.16), abutment sizes ≤ 10 mm (fourfold, CI 3.99-4.12) and male gender (9%, CI 1.07-1.12). Granulation episodes were affected by cardiovascular disease (CVD) status (1.5-fold, CI 0.26-0.78), BIA400 implant (threefold, CI 8.8.-9.2) and abutment sizes ≤ 10 mm (fourfold, CI 3.6-3.73). Revision surgery episodes increased with diabetic status (1.2-fold, CI 0.06-0.37) and abutment sizes ≤ 10 mm (threefold, 3.303-3.304).
CONCLUSIONS: Larger cohort studies are required to confirm findings, particularly for implant and abutment size contributions. However, the findings suggest that using a larger abutment size when skin thickness meassuremets are borderline, improved hygiene education in male patients, pre-operative optimisation of CVD and diabetes, and adjusted patient follow-up based on risk stratification of the contributing factors to complication rates could reduce complication rates.