电子鼻咽喉镜直视下环杓关节拨动复位术治疗环杓关节脱位的疗效分析

Curative effect of cricoarytenoid joint reduction under direct visualization through electronic nasopharyngoscope in the treatment of arytenoid dislocation

摘要:

目的 探讨电子鼻咽喉镜直视下环杓关节拨动复位治疗的疗效，为环杓关节脱位的治疗提供参考。方法 回顾性分析2016年9月—2021年3月收治17例明确诊断为单侧环杓关节脱位并在局部麻醉下经电子鼻咽喉镜直视下环杓关节拨动复位术的患者临床资料，比较拨动复位前后电子鼻咽喉镜检查、发声障碍指数量表（VHI-10）及听觉感知（GRABS）评估总嘶哑度G。结果 治疗前17例患者均有发音疲劳、不同程度的声音嘶哑、声带运动障碍及声门闭合不良。17例患者经复位术后4周均诉发音嘶哑改善；电子鼻咽喉镜检查声带运动恢复正常15例（88.24%）；2例（11.76%）患侧声带动度较术前改善，但仍较健侧稍差，声门闭合较前改善。与复位前比较，复位后VHI-10功能、生理、情感三个维度及总分均降低（P<0.05）；G0为8例，G1为7例，G2为2例。结论 局部麻醉下电子鼻咽喉镜直视下杓状软骨拨动复位是治疗环杓关节脱位的安全、简便、有效的方法。

Abstract:

Objective To investigate the curative effect of cricoarytenoid joint reduction under direct visualization through electronic nasopharyngoscope in the treatment of arytenoid dislocation.Methods Retrospective analysis was performed on the data of 17 cases with unilateral arytenoid dislocation hospitalized in our department between Sept 2016 and March 2021. All the patients underwent cricoarytenoid joint reduction under local anesthesia through electronic nasopharyngoscope. The preoperative results of voice handicap index (VHI-10)， GRABS assessment，electronic nasolaryngoscopy were compared with those after reduction.Results Before reduction, all the 17 cases had fatigue of voice, and different degrees of hoarseness, vocal cord movement disorder as well as incomplete glottal closure. Four weeks after reduction, the voice of all patients improved. Nasopharyngoscopy revealed that the movement of affected vocal cord returned to normal in 15 cases (88.24%) and improved in 2 (11.76%). The total scores of VHI-10, those of physiology, function as well as emotion dimensions in VHI-10 were lower than those before reduction (P<0.05). GRABS ratings were G0 in 8 patients, G1 in 7 and G2 in 2.Conclusion The cricoarytenoid joint reduction under local anesthesia through electronic nasopharyngoscope is a safe, effective and simple method for the treatment of arytenoid dislocation.