喉挫伤致环杓关节脱位的诊治

Diagnosis and treatment of cricoarytenoid dislocation from blunt laryngeal trauma

目的探讨喉挫伤致环杓关节脱位的诊治要点。方法回顾性分析1993年1月～2005年12月收治的13例患者的临床资料。所有患者均行纤维喉镜和视屏频闪动态喉镜检查。7例予喉部螺旋CT扫描。均在表面麻醉下行环杓关节拨动复位术及发声练习。结果13例喉挫伤患者伤后均有气息样声嘶。就诊时间为伤后14—240d，平均68d。检查可见患侧声带固定或受限，声门闭合不全，双侧声带突不在同一平面。前脱位13例，其中1例伴有对侧后脱位。患侧声带振动存在。喉部CT扫描3例可见杓状软骨向前移位。治愈5例，好转3例，无效5例。结论通过病史结合频闪动态喉镜检查可对喉挫伤所致的环杓关节脱位作出诊断。表面麻醉下行环杓关节拨动复位术能使关节复位或减轻双侧声带突垂直方向的差异，有助于声门闭合而改善发声。发声训练的方法应取决于患侧杓部有无微动。早期治疗效果较好。

Objective To investigate the diagnosis and treatment of cricoarytenoid dislocation from blunt laryngeal trauma. Methods Thirteen patients with cricoarytenoid dislocation from blunt laryngeal trauma treated in our hospital from January 1993 to December 2005 were analyzed retrospectively. All patients were examined by using fibrolaryngoscope and videostrobolaryngoscope. Of them, 7 patients were examined by spiral CT scanning. All patients underwent closed reduction under topical anesthesia and voice training. Results All patients had breathy hoarseness. Interval from injury to treatment was 14-240 days （mean 68 days）. Immobility or impaired movement of the vocal cords leading to glottic imcomplete closure was detected. Vertical level difference of the bilateral vocal processes was also observed. All the patients had anterior cricoarytenoid dislocation, one of which was accompanied by posterior dislocation. There found vibrations of the vocal cord in the affected side. Laryngeal CT scanning showed arytenoid displacement in 3 patients. As a result, 5 patients were cured, 3 improved and 5 unchanged. Conclusions Cricoarytenoid dislocation can be diagnosed by case history combined with videostrobolaryngoscope. Closed reduction under topical anesthesia may reestablish joint mobility and equalize the heights of the vocal processes. The selection of voice training technique is up to the presence of arytenoid vibration in the affected side. Early treatment will improve therapeutic results.