双蒂肌转入充填联合杓状软骨内移喉成形术治疗单侧声带麻痹

Sternum-hyoid muscle transposition and arytenoid adduction for unilateral vocal cord paralysis

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.

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 The lamina was retracted laterally, and a 3-0 prolene suture was placed through the muscular process and tied to the cricoid cartilage at the origin of the lateral cricoarytenoid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.