改良杓状软骨复位术治疗环杓关节脱位  

Modified closed reduction for the arytenoid cartilage dislocation

作　　者：徐文[1] 韩德民[1] 胡蓉[1] 张丽[1] 朱红[1] 

机构地区：[1]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科教育部耳鼻咽喉头颈科学重点实验室(首都医科大学),100730

出　　处：《中华耳鼻咽喉头颈外科杂志》2013年第6期450-454,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：国家自然基金面上项目（81170901）;北京市自然基金面上项目（7132053）;北京市卫生系统高层次卫生技术人才骨干基金（2009-3-33）

摘　　要：目的探讨环杓关节脱位临床特征及改良杓状软骨复位术的疗效。方法改良杓状软骨复位术，即应用直角喉钳握持杓状软骨上部表面，根据脱位位置将杓状软骨向后外侧或前内侧方向旋转拨动。67例声带运动不良患者表面麻醉间接喉镜下行改良杓状软骨复位术，其中全身麻醉插管导致环杓关节脱位57例，非插管原因10例（6例为顿挫性喉外伤）。对患者临床特征、嗓音功能、手术方法及疗效进行分析。结果患者均有明显声音嘶哑，频闪喉镜下均见不同程度的声带运动障碍（50例为左侧，占74．6％）及声门闭合不良，杓状软骨向前内侧移位63例，向后外侧移位4例。行喉肌电图检查的38例插管患者中，10例（26．3％）肌电异常，可见失神经电位。改良杓状软骨复位后，57例全身麻醉插管导致环杓关节脱位患者声音均有改善，其中51例发音正常，6例轻度嘶哑；54例声带运动恢复正常，3例声带运动改善。10例非插管原因患者中，声带运动及发音7例恢复正常，1例改善，2例无效。结论环杓关节脱位部分病例合并喉返神经损伤（多为暂时性损伤），脱位后6周内改良杓状软骨复位术可使声带运动及发音功能得到满意恢复。钝挫性喉外伤导致的声带运动不良原因复杂，即使杓状软骨复位，喉部瘢痕挛缩也可能影响疗效。Objective To investigate the clinical characteristics of arytenoid cartilage dislocation and the outcome of modified closed reduction. Methods Sixty-seven patients with vocal fold immobility underwent modified closed reduction under local anesthesia through indirect laryngoscope. During reduction, a right-angled laryngeal forceps was used to hold the superior surface of the affected arytenoids and rotate in posterolateral or anteromedial direction according different situation of dislocation. Fifty-seven patients had previously undergone endotraeheal intubation for surgery and 10 patients had nonintubated injury with blunt laryngeal trauma in 6 cases. Clinical characteristics, voice function, procedural skill and therapy outcome of those cases were evaluated. Results All patients complained of persistent hoarseness. Stroboseopy revealed vocal fold immobility （50 of 67 cases on the left side, 74. 6% ） and incomplete glottal closure with anterior arytenoid dislocations in 63 cases and posterior dislocations in 4 cases. The laryngeal electromyography （LEMG） results for 10 of 38 patients （26. 3% ） of postintubation arytenoids dislocation displayed abnormal patterns with denervated potentials. The voice of all patients for postintubation arytenoids dislocation improved after modified closed reduction with normal in 51 cases and slight hoarseness in 6 cases. The movement of the affected vocal folds recovered to normal in 54 cases and improved in 3 cases. Among the 10 patients with nonintubated vocal fold immobility, the voice and the movement of vocal folds were normal in 7 cases, improved in 1 case and no effective in 2 cases. Conclusions Some cases of arytenoid dislocation were accompanied by an recurrent laryngeal nerve abnormality （mostly temporary and resolved after a reduction）. The modified reduction technique under local anesthesia can restore patients＇ voice and vocal fold mobility within 6 weeks after dislocation. Nevertheless, the causes of vocal fold immobility followingblunt laryngeal tra

关 键 词：杓状软骨 环状软骨 脱位 声带麻痹 

分 类 号：R76[医药卫生—耳鼻咽喉科]