CAJ | 학술논문

目的探讨双蒂胸骨舌骨肌瓣转入声门旁联合杓状软骨内移治疗单侧声带麻痹的疗效.方法不适合行喉返神经探查修复术的单侧声带麻痹19例.在甲状软骨板正中旁开0.5 cm裂开甲状软骨板,在杓状软骨内收固定的同时将带双蒂的胸骨舌骨肌瓣转入患侧声门旁内.治疗前后以电子喉镜、频闪喉镜、嗓音听评委主观评估、声学参数客观分析等评价治疗效果.结果所有患侧声带膜部及声带突部术后即刻均明显内移,声带体积增大,发声时增大更为明显.术后2个月声门后裂隙消失6例,缩小13例;12个月后嗓音总嘶哑度评估:恢复正常6例,轻度声嘶12例,中度声嘶1例,较术前明显好转,采用等级资料数据秩和检验,差异具有统计学意义(z值为-4.062,P＜0.01).术后12个月的声门后裂隙、嗓音总嘶哑度与术后2个月比较无明显区别(P值均＞0.05).术后2个月及12个月声学客观指标的4个参数(基础频率、频率微扰、振幅微扰和谐噪比)平均值均明显小于术前,最长声时明显长于术前,差异均有统计学意义(P值均＜0.05).术后12个月与2个月比较上述参数差异均无统计学意义(P值均＞0.05).结论双蒂胸骨舌骨肌充填联合杓状软骨内移喉成形术治疗不适合行喉返神经探查修复术的单侧声带麻痹患者的创伤小,无排异反应,远期效果较稳定.
목적 탐토쌍체흉골설골기판전입성문방연합표상연골내이치료단측성대마비적료효.방법 불괄합행후반신경탐사수복술적단측성대마비19례.재갑상연골판정중방개0.5 cm렬개갑상연골판,재표상연골내수고정적동시장대쌍체적흉골설골기판전입환측성문방내.치료전후이전자후경、빈섬후경、상음은평위주관평고、성학삼수객관분석등평개치료효과.결과 소유환측성대막부급성대돌부술후즉각균명현내이,성대체적증대,발성시증대경위명현.술후2개월성문후렬극소실6례,축소13례;12개월후상음총시아도평고:회복정상6례,경도성시12례,중도성시1례,교술전명현호전,채용등급자료수거질화검험,차이구유통계학의의(z치위-4.062,P＜0.01).술후12개월적성문후렬극、상음총시아도여술후2개월비교무명현구별(P치균＞0.05).술후2개월급12개월성학객관지표적4개삼수(기출빈솔、빈솔미우、진폭미우화해조비)평균치균명현소우술전,최장성시명현장우술전,차이균유통계학의의(P치균＜0.05).술후12개월여2개월비교상술삼수차이균무통계학의의(P치균＞0.05).결론 쌍체흉골설골기충전연합표상연골내이후성형술치료불괄합행후반신경탐사수복술적단측성대마비환자적창상소,무배이반응,원기효과교은정.
Objective To explore the therapeutic effect of sternum-hyoid muscle transposition and arytenoid adduction for unilateral vocal cord paralysis (UVCP). Methods Included in this study were 19 patients with UVCP lasted for 12 months to 15 years. The surgical technique was as follows. The thyroid cartilage was engaged with a skin hook and gently rotated anteriorly. The lateral-inferior corner of the thyroid cartilage was exposed and the muscular process of the arytenoid was identified. Then, the thyroid lamina on the involved side was parasagittally separated 5 mm off the midline. The inner perichondrium was carefully freed from the overlying thyroid cartilage. The lamina was retracted laterally, and a 3-0 prolene suture was placed through the muscular process and tied to the cricoid cartilage at the origin of the lateral cricoarytenoid muscle. A bipedicled strap muscle flap was then transposed into the space between the lamina and the inner perichondrium. Pre- and postoperative voice evaluations measured mean fundamental frequency, jitter,shimmer, harmonic ratio and maximal phonation time, as well as assessments of voice quality. Results Vocal improvement was obtained in 100% ( 19 of 19) of patients. Immediately after the operation, the ingression could be obsered in vocal cord membrane and vocal process, vocal cord volume was amplified.There was a significant difference (P ＜0. 05) in all parameters (fundamental frequency, jitter, shimmer,harmonic ratio and maximal phonation time) between pre- and postoperative voice evaluations measured mean. There was no significant difference ( P ＞ 0. 05 ) in voice evaluations measured mean between 2 months and 12 months after operation in all patients. No major complications were noted in any patient. Conclusion Sternum-hyoid muscle transposition and arytenoid adduction for unilateral vocal cord paralysis is simple and convenient, no immune rejection, and the long-term result is stable.