先天性腭裂患者术中凿断翼钩对语音及中耳功能的影响

The effect of pterygoid hamulus fracture on speech and otitis media in patients with cleft palate

目的:研究在腭裂修复术中,凿断翼钩对腭裂患者中耳及语音的影响。方法:复习133例腭裂手术患者的临床资料,所有患者均排除全身多发畸形及腭心面综合征;手术采用vonLangenbeck方法90例,Veau两瓣法43例;术中凿断翼钩的67例,未凿断翼钩的66例。术后在颅颜中心和耳鼻喉科定期复查,进行语音评估和检查中耳有无感染、有无听力障碍。采用Statistica4.0进行统计学分析。结果:翼钩凿断的患者中,最早在11个月后出现中耳炎,最晚在76个月出现中耳炎,平均13.4个月;未凿断翼钩的患者中,最早在12个月出现中耳炎,最晚在120个月出现中耳炎,平均13.9个月。两者无显著差异(P>0.05)。凿断翼钩有完整评估资料的44例患者中,平均随访51.7个月,其中腭咽闭合(VPC)36例,临界(M)5例,腭咽闭合不全(VPI)3例,分别占81.8%、11.4%和6.8%;未凿断翼钩的44例中,平均随访53.5个月,VPC32例,M8例,VPI4例,分别占77.3%、14.8和7.9%。两者无显著差异(P>0.05)。结论:翼钩在腭裂手术中的凿断与否,与腭裂患者在术后出现中耳感染之间无显著相关性,与术后出现腭咽闭合不全的几率也无必然的联系。

PURPOSE： To study the effect of pterygoid hamulus fracture on the mid-ear and speech of patients with palatoplasty. METHODS： 133 cleft palate patients were analyzed, all of whom were excluded multi-malformation and palate-heart-face syndrome. 90 of them received von Langenbeck surgery, and 43 received Veau two flaps. They were divided into 2 groups： patients with pterygoid hamulus fracture （67 patients） and patients without pterygoid hamulus fracture （66 patients）. Then the patients had follow-ups to ENT to find out otitis media and speech assessment in eraniofaeial center. The data was analyzed with Statistiea 4.0 software package. RESULTS： In the pterygoid hamulus fracture group, the appearance of otitis media began from 11 to 76 months after palatoplasty, with an average time of 13.4 months. Patients without pterygoid hamulus fracture were found otitis media from 12 to120 months after palatoplasty,with an average time of 13.9 months. There was no significant difference between the two groups （P〉0.05）. In speech evaluation, there were 36 VPC （81.8%）, 5 M （11.4%）, 3 VPI （6.8%） in 44 patients with pterygoid hamulus fracture after 51.7 months of follow-up in average. There were 32 VPC （77.3%）, 8 M （14.8%）, 4 VPI （7.9%） in 44 patients without pterygoid hamulus fracture after 53.5 months of follow-up in average. There was still no significant difference between the two groups （P〉0.05）. CONCLUSION： There was no significant relation between otitis media and pterygoid hamulus fracture, and no significant relation between pharyngeal inability and pterygoid hamulus fracture.