摘要
目的探讨声带麻痹与环杓关节脱位的临床特征对其诊断及鉴别诊断的价值。方法分析88例单侧声带麻痹、27例单侧环杓关节脱位患者的临床资料,比较其病因、喉部形态特点及喉肌电图特征。结果 88例声带麻痹患者的病因分别为:手术损伤(45例)、颈部外伤(2例)、特发性(16例)、感染(16例)及喉外肿瘤侵犯或压迫因素导致喉返神经受损所致(9例);27例环杓关节脱位患者中有气管插管史24例,有胃管插入史3例。声带麻痹组与环杓关节脱位患者声带固定于旁正中位最常见,其次为外展位及正中位;两组在声带形态、双声带垂直相对称性、黏膜波动、声门上代偿、声门闭合程度、杓状软骨形态及活动方面差异不明显。声带麻痹组患者喉肌电图出现失神经电位或再生电位,或呈电静息,募集电位呈单纯相或混合相,诱发电位均消失;环杓关节脱位组喉肌电图正常20例(74.07%,20/27),明显异常7例(25.93%,7/27);声带麻痹组患者中54例(61.36%)有喉肌联带运动,有联带运动者弓形声带比例低、双声带水平不一致的比例高;损伤组患者中多数病程在1月内或有联带运动者声带固定于正中位。结论声带麻痹与环杓关节脱位病因不同;喉部形态学特点对于声带麻痹与环杓关节脱位的鉴别存在局限性,肌电图是鉴别二者的重要手段;声带麻痹患者声带形态、固定位置与病程、神经再生及联带运动有关,环杓关节脱位患者可合并喉返神经功能异常。
Objective To investigate the value of clinical characteristics in diagnosis of vocal fold paralysis（VFP）and arytenoid dislocation.Methods Eighty-eight patients of VFP and 27 patients of arytenoid dislocation were studied,by comparing the causes,laryngeal morphologic characteristics and laryngeal electromyography（LEMG）.Results The causes of 88 VFP patients included surgery（45cases）,neck trauma（2cases）,idiopathic causes（16cases）,infection（16cases）,and tumor invasion-related（9cases）.Of the 27 arytenoid dislocation patients,24 had a history of endotracheal intubation and the others had a history of gastric tube insertion.The vocal folds were mostly fixed at the paramedian position,followed by the abducent position and the median position.No significant differences were found in laryngeal morphologic characteristics between the two groups,including vocal fold shape,glottis vertical symmetry,mucosal waves,supraglottic compensation,glottis closure and arytenoid movement.The LEMG of VFP patients appeared as denervation patterns,reinnervation potentials,or electrical silence;the recruitment patterns appeared as mix or simple patterns;the evoked potentials were absent.Of the VFP patients,54cases（61.36%%）were found synkinesis of involved posterior cricoarytenoid and two of them also involved thyroatenoid.The patients with synkinesis had lower percentage of vocal fold bowing and higher percentage of glottic vertical asymmetry compared to the ones without synkinesis.Of the VFP patients whose cause was surgery or neck trauma,the median-position fixed vocal folds were mostly observed in the patients with duration of less than 1month or with synkinesis.Of the 27 arytenoid dislocation patients,20（74.07%）showed normal LEMG patterns and 7（25.93%）showed apparent LEMG abnormality on the affected side.Conclusion The causes of vocal fold paralysis and arytenoid dislocation are different.Laryngeal morphologic characteristics have limitations in distinguishing vocal fold paralysis from arytenoid dislocation.The shape and position of involved vocal folds of the VFP patients are correlated with duration,nerve regeneration and synkinesis.
出处
《听力学及言语疾病杂志》
CAS
CSCD
北大核心
2015年第4期367-371,共5页
Journal of Audiology and Speech Pathology
基金
北京市卫生系统高层次人才学科带头人项目(2014-2-2004)
北京市自然科学基金(7132053)资助
关键词
声带麻痹
环杓关节脱位
喉肌电图
频闪喉镜
Vocal fold paralysis
Arytenoid dislocation
Laryngeal electromyography
Strobolaryngoscopy
