Хирургические подходы к повышению эффективности реабилитации больных с глухотой методом кохлеарной имплантации
![Диссертация: Хирургические подходы к повышению эффективности реабилитации больных с глухотой методом кохлеарной имплантации](https://westud.ru/work/5175222/cover.png)
Диссертация
Хирургический этап кохлеарной имплантации является безальтернативным звеном данного реабилитационного метода. Стратегическая цель операции остается неизменной с момента разработки кохлеарной имплантации: расположить электроды максимально близко к дистальному отделу слухового нерва лестницы улитки, модиолюс), разместить приемник-стимулятор на поверхности черепа с учетом предстоящего его… Читать ещё >
Содержание
- Глава 1. Обзор литературы. Современное состояние и перспективы развития хирургического этапа кохлеарной имплантации
- 1. 1. Краткая историческая справка и становление хирургии уха при кохлеарной имплантации (КИ)
- 1. 2. Принципы выбора стороны хирургического вмешательства
- 1. 2. 1. Возможности компьютерной томографии (КТ) височных костей в прогнозировании результата хирургического этапа КИ
- 1. 2. 2. Промонториальный тест (ПТ) и выбор стороны хирургического вмешательства при КИ
- 1. 3. Составляющие хирургического этапа КИ
- 1. 3. 1. Варианты кожных разрезов и их особенности
- 1. 3. 2. Доступ к улитке
- 1. 3. 2. 1. Модифицированные доступы к улитке
- 1. 3. 2. 2. Критический анализ подходов к улитке
- 1. 3. 3. Фиксация приемника-стимулятора (ПС)
- 1. 3. 4. Формирование кохлеостомы и интракохлеарное размещение электродов
- 1. 3. 5. Стабилизация электродной цепи и провода
- 1. 3. 6. Особенности интраоперационного исследования функции слуховых проводящих путей
- 1. 4. Некоторые особенности хирургического этапа КИ
- 1. 4. 1. Своеобразие хирургического вмешательства при КИ у детей
- 1. 4. 2. Заболевания среднего уха и хирургический этап КИ
- 1. 4. 3. Особенности вмешательства в условиях оссификации улитки
- 1. 4. 4. Пороки развития уха и КИ
- 1. 5. Осложнения хирургического этапа КИ
- 1. 6. Сопутствующие заболевания и планирование хирургического этапа КИ
- Пути совершенствования хирургического этапа КИ и перспективы его развития
- Глава 2. Характеристика больных, материал и методы исследования
- 2. 1. Характеристика оперированных пациентов и примененные кохлеарные импланты
- 2. 2. Методика проведения электростимуляции улики
- 2. 3. Методика рентгенологического исследования височной кости применительно к КИ
- 2. 4. Характерные черты хирургического вмешательства при КИ
- 2. 5. Методы исследования слуха, использованные в работе
- 2. 6. Инструмент исследования качества (КЖ) и его обоснование при КИ
- Результаты исследования
- Глава 3. Роль предоперационной электростимуляции улитки в выборе стороны хирургического вмешательства
- Глава 4. Обеспечение надежного укрытия имплантируемой части устройства в условиях ограниченного операционного поля
- 4. 1. Исследование влияния разреза кожи и подлежащих тканей на темпы послеоперационного заживления
- 4. 1. 1. Характеристика примененного разреза, исключающего создание кожного лоскута
- 4. 1. 2. Дополнительные подкожные лоскуты и их преимущества
- 4. 1. 3. Сравнительная оценка типов кожных разрезов
- 4. 1. 4. Особенности использования электроинструментов для рассечения тканей
- 4. 1. Исследование влияния разреза кожи и подлежащих тканей на темпы послеоперационного заживления
- 5. 1. Развитие лигатурной фиксации
- 5. 2. Обоснование и разработка альтернативного лигатурному способа фиксации приемника-стимулятора
- 5. 3. Предупреждение дислокации электродной цепи импланта
- 5. 3. 1. Рост костей черепа и точки естественной фиксации проводника и электродной цепи
- 5. 3. 2. Создание компенсаторной петли провода
- 6. 1. Размеры и пространственная ориентация улитки в планировании хирургического этапа КИ
- 6. 2. Особенности интракохлеарного расположения электродов и этиология глухоты
- 6. 3. Значение глубины введения электродов в улитку для послеоперационной реабилитации пациентов
- 8. 1. Хирургический этап кохлеарной имплантации и качество жизни
- 8. 2. Качество жизни у взрослых пациентов с постлингвальной глухотой и хирургический этап КИ
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