Clinical Application Of Xenogenic Acellular(Bovine)Dermal Matrix With Autologous Bone Powder Implantation In Open Mastoidectomy

Xenogenic acellular(bovine)dermal matrix(ADM)combined with autologous bone powder implantation in open radical mastoidectomy can significantly shorten the dry ear time and epithelialize the operative area after the operation,and ean quickly and effectively make the implanted autologous bone powder survive,thus effectively reducing the incidence of infection after the operation,improving the prognosis and reducing the number of dressing changes after the operation,improve the quality of life of patients.Objective:The purpose of this study was to investigate the application of xenogenic acellular(bovine)dermal matrix(ADM)combined with autologous bone powder implantation in open mastoidectomy.The patients could dry ears anci epithelialize quickly 4-6 weeks after operation.The implanted autologous bone powder could survive quickly and effectively,and the infection rate could be reduced effectively.Methods:From September 2016 to September 2018,patients with otitis media were treated surgically in Department ? of Otolaryngology,First Affiliated Hospital of Kunming Medical University.According to the inclusion criteria of this study,the subjects were screened,which accorded with the indications and exclusion contraindications of open radical mastoidectomy,without other infectious diseases and infectious factors,without intellectual impairment,and could follow the doctor's instructions and return to our department.All patients need to improve the temporal bone and ear CT(crown+axis),pure tone audiometry,acoustic immittance,brainstem response audiometry,otoendoscopy,and cranial MRI if necessary.Before operation,it is necessary to make sure that patients are not accompanied by other infectious diseases and infectious factors,and are not accompanied by mental retardation.They can regularly follow the doctor's instructions and come to our department for dressing change and reexamination.Patients with surgical indications and contraindications for side-by-side exclusion surgery were divided into three groups according to the experimental requirements of this study:1.Patients with otitis media who underwent open mastoidectomy+xenogenie acellular(bovine)dermal matrix(ADM)combined with autologous bone powder implantation(experimental group);2.Patients with otitis media who underwent open mastoidectomy+fascia combined with autologous bone powder implantation(experimental control group)3.Open radical mastoidectomy plus fascial implantation(blank control group)was performed for otitis media.The patients in three groups(1),dry ear(2),epithelialization(3),bone powder survival(4)and infection were recorded in detail at 2,4,6 and 8 weeks after operation,respectively.Then,the patients in three groups were eompared(drug change time>8 weeks were recorded separately,not included in the above-mentioned inter-group ratio).SPSS24.0 was used for statistical correlation analysis.Results:Statistical analysis:The collected case data are put into EXCEL to form a database.Data analysis is carried out by SPSS24.0.Measurement data are expressed in the form of mean(+standard deviation).Variance analysis is used for inter-group comparison,and counting data are expressed in the form of frequency and rate.Chi-square test is used for inter-group comparison.Fisher's exact probability method is used for non-confornity.The above methods all take=0.05 as the test level.When comparing two methods,the test level is adjusted according to the number of comparisonsa?0.017.In this study,277 patients,138 males and 139 females,aged between 16 and 76 years,were included.There were 93 cases in the blank control group,including 46 males(49.46%)and 47 females(50.54%);the oldest was 74 years old,the youngest was 17 years old,and the average age was(42.87+9.88);43 males(47.78%)and 47 females(52.22%)were in the experimental group;the oldest was 74 years old,the youngest was 17 years old,and the average age was(41.48+10.10).There were 49 males(52.13%)and 45 females(47.87%)in the control group.The oldest was 76 years old and the youngest was 16 years old,with an average age of(43.27+ 10.16)years old.The results of variance analysis showed that P>0.05.There was no significant difference in age among the three groups,indicating that there was no difference in age among the three groups and there was comparability.The results of Chi-square test showed that there was no significant difference between the three groups in gender distribution,which indicated that there was no difference in gender distribution among the three groups and there was comparability.The incidence of dry ear was compared between the three groups 2 weeks after operation.Chi-square test showed that the incidence of dry ear was significantly higher in the experimental group than in the blank control group 2 weeks after operation.The results showed that the incidence of dry ear in the experimental group was higher than that in the blank control group and the experimental control group 2 weeks after operation.The number of cases of epithelialization and infection in the other observation items of the three groups were all 0.The incidence of dry ear was compared between groups 4 weeks and 3 weeks after operation.Chi-square test showed that the incidence of dry ear was significantly higher in the experimental group than that in the blank control group.The test level was adjusted and compared between the two groups.The results showed that the incidence of dry ear in the experimental group was higher than that in the blank control group and the experimental control group at 4 weeks after operation.There was no difference between the blank control group and the experimental control group.The incidence of epithelialization was compared between the groups 4 weeks and 3 weeks after operation.Chi-square test showed that there was significant difference in the incidence of epithelialization among the three groups.The level of test was adjusted and two comparisons were made.The results showed that the incidence of epithelialization in the blank control group,the experimental control group and the experimental group were all P<0.001,indicating that the incidence of epithelialization in the three groups was different after 4 weeks.The incidence of epithelialization in the experimental group was higher than that in the blank control group and the experimental control group,but there was no difference in the infection rate between the three groups at 4 weeks after operation(P>0.05).The incidence of dry ear was compared between groups 6 weeks and 3 weeks after operation.The Chi-square test showed that the incidence of dry ear was significantly higher in the experimental group than in the blank control group.The test level was adjusted and the two groups were compared.The results showed that the incidence of dry ear in the experimental group was higher than that in the blank control group and the experimental control group at 6 weeks after operation.There was no difference between the blank control group and the experimental control group(P>0.05).The incidence of epithelialization was compared between the three groups 6 weeks after operation.The results of chi-square test showed that the incidence of epithelialization was significantly different among the three groups.The level of test was adjusted and two comparisons were made.The results showed that the incidence of epithelialization in the blank control group,the experimental control group and the experimental group were all P<0.001.The incidence of epithelialization in the experimental group was higher than that in the blank control group and the experimental control group at 6 weeks postoperatively,but there was no difference among the three groups at 6 weeks postoperatively(P>0.05).The incidence of dry ear,epithelialization and infection were compared between groups at 8 weeks and 3 weeks after operation.The results were all P>0.05.There was no significant difference in the incidence of dry ear,epithelialization and infection between groups at 8 weeks and 3 weeks after operation.The survival rate of autologous bone meal was compared between the experimental group and the experimental control group at 4 weeks,6 weeks and 8 weeks after operation.Fisher,s exact probability method was used,The results showed that the survival rate of autologous bone meal was different between the two groups at 4 weeks and 6 weeks after operation(P<0.001),but there was no difference at 8 weeks after operation(P>0.05).Conclusion:Xenogenic acellular(bovine)dermal matrix(ADM)combined with autologous bone powder implantation in open radical mastoidectomy can significantly shorten the dry ear time and epithelialize quickly after operation.It can achieve dry ear and epithelialization within 4 to 6 weeks after operation,and ensure the survival of autologous bone powder implantation,thus effectively reducing the incidence of infection after operation,improving long-term efficacy.