Objective: To explore the clinical efficacy of stapes prosthesis surgery for the treatment of congenital fixation of stapes or oval window atresia in pediatric patients. Methods: The clinical data of children with congenital fixation of stapes or oval window atresia who underwent stapes prosthesis surgery in Xi'an Children's Hospital from January 2017 to July 2025 were retrospectively analyzed. All the children underwent high-resolution computed tomography (HRCT) of the temporal bone and pure-tone audiometry before and after the surgery. According to the type of auditory chain deformity, the children were divided into the stapes fixation group and the oval window atresia group. The surgical methods included incudovestibular fenestration (IVF) and malleovestibulopexy (MVP), with four types of opening methods, namely stapes footplate drilling, stapes resection, vestibular windowing, and vestibular semicircular canal interposition, respectively. The preoperative and postoperative air-conducted pure tone average (PTA), bone-conducted PTA, and air-bone conduction difference (ABG) were observed and compared. Results: A total of 19 children (25 ears) aged (8.9±3.1) years were included, with 13 males and 6 females. There were 13 ears on the right side and 12 ears on the left side. Preoperative HRCT yielded a positive diagnostic rate of 56.0% (14/25), while the incidence of facial nerve malformation was 40.0% (10/25). Surgical intervention was performed in 24 of the 25 affected ears. Among these, 13 ears were diagnosed with stapes fixation, of which four underwent IVF and nine underwent MVP. The remaining 11 ears presented with oval window atresia, with four undergoing IVF and seven undergoing MVP. Six months postoperatively, both the stapes fixation group and oval window atresia group demonstrated statistically significant improvements in air-conduction PTA and ABG compared with preoperative values. In the stapes fixation group, air-conduction PTA decreased from (62.2±8.7) dB HL to (32.8±10.8) dB HL (P=0.002), and ABG improved from (49.3±10.5) dB HL to (22.5±5.8) dB HL (P<0.001). In the oval window atresia group, air-conduction PTA decreased from (66.2±8.4) dB HL to (42.0±11.6) dB HL (P<0.001), and ABG improved from (54.0±5.0) dB HL to (31.1±11.7) dB HL (P<0.001). No statistically significant differences were observed in bone-conduction PTA before and after surgery in either group (both P>0.05). Intergroup comparisons revealed that the stapes fixation group exhibited significantly greater improvements in postoperative air-conduction PTA [(32.8±10.8) dB HL vs (42.0±11.6) dB HL] and ABG [(22.5±5.8) dB HL vs (31.1±11.7) dB HL] compared with the oval window atresia group (both P<0.05). Subgroup analyses based on surgical technique showed that patients who underwent MVP in both the stapes fixation and oval window atresia groups achieved statistically significant reductions in ABG compared with preoperative levels (both P<0.05). In contrast, IVF did not yield statistically significant improvements in ABG in either group (both P>0.05). No statistically significant difference was detected in postoperative ABG between patients who underwent IVF versus MVP, nor among the four different types of window opening techniques (all P>0.05).All patients received outpatient follow-up at six months postoperatively. Nineteen ears were followed up for≥1 year, with a mean duration of (25.1±12.4) months, while five ears were lost to follow-up (loss to follow-up rate: 20.8%). No serious complications, including sensorineural hearing loss or facial paralysis, were reported in any patient. Conclusions: Stapes prosthesis surgery for the management of congenital stapes fixation and oval window atresia in pediatric patients demonstrates a favorable safety profile and sustained therapeutic efficacy. Surgical outcomes for congenital stapes fixation are superior to those for oval window atresia. Neither the choice between IVF and MVP nor variations in window-opening techniques has a statistically significant effect on postoperative hearing outcomes.
目的： 探讨人工镫骨手术治疗儿童先天性镫骨固定或前庭窗闭锁的临床效果。 方法： 回顾性分析2017年1月至2025年7月在西安市儿童医院行人工镫骨手术治疗的先天性镫骨固定或前庭窗闭锁患儿临床资料，患儿手术前、后均行颞骨高分辨率CT（HRCT）及纯音听阈测定。按听骨链畸形类型分为镫骨固定组与前庭窗闭锁组，手术方式包括砧骨前庭桥接术（IVF）和锤骨前庭桥接术（MVP），分别采用镫骨底板钻孔、镫骨底板切除、前庭开窗和前庭半规管间开窗4种开窗方式。观察并比较患者术前、术后的气导平均听阈（PTA）、骨导PTA及气骨导差（ABG），评估手术疗效。 结果： 共纳入患儿19例（25耳），男13例，女6例，年龄（8.9±3.1）岁，右侧13耳，左侧12耳。术前HRCT诊断阳性率为56.0%（14/25）。面神经畸形发生率为40.0%（10/25）。25耳中24耳完成手术，镫骨固定组13耳，其中4耳行IVF，9耳行MVP；前庭窗闭锁组共11耳，其中4耳行IVF，7耳行MVP。术后6个月镫骨固定组和前庭窗闭锁组气导PTA［（32.8±10.8）分贝听力级（dB HL）比（62.2±8.7）dB HL，（42.0±11.6）dB HL比（66.2±8.4）dB HL，均P<0.05］及ABG［（22.5±5.8）dB HL比（49.3±10.5）dB HL，（31.1±11.7）dB HL比（54.0±5.0）dB HL，均P<0.001］均较术前改善。镫骨固定组和前庭窗闭锁组手术前后骨导PTA差异均无统计学意义（均P>0.05）。镫骨固定组术后气导PTA［（32.8±10.8）dB HL比（42.0±11.6）dB HL］、ABG［（22.5±5.8）dB HL比（31.1±11.7）dB HL］改善幅度均优于前庭窗闭锁组（均P<0.05）。与术前比较，行MVP的镫骨固定组和前庭窗闭锁组患者术后ABG均改善（均P<0.05），行IVF的两组患者手术前后ABG比较差异均无统计学意义（均P>0.05）。IVF与MVP两种术式的患者术后ABG差异均无统计学意义（均P>0.05）。采用四种不同开窗方式的患者术后听力差异无统计学意义（均P>0.05）。所有患儿于术后6个月在门诊进行随访，19耳随访时间≥1年［（25.1±12.4）个月］，5耳失访（失访率20.8%），均未出现感音神经性耳聋、面瘫等严重并发症。 结论： 人工镫骨手术治疗儿童先天性镫骨固定和前庭窗闭锁安全有效，术后听力改善稳定；镫骨固定的手术效果优于前庭窗闭锁。IVF与MVP两种术式或不同的开窗方式对术后听力无明显影响。.