动态喉镜记波扫描评估单侧声带麻痹患者的声带振动功能

The Clinical Applications of Videostrobokymography in Patients with Unilateral Vocal Cord Paralysis

目的探讨应用动态喉镜记波扫描(videostrobokymography,VSK)评价单侧声带麻痹患者声带振动功能的可行性。方法晚期症状性单侧声带麻痹患者55例,其中记录不到基频的患者17例,可以记录到基频的患者38例,选取与这38例性别和年龄相匹配的正常对照组38例。所有受试者均行动态喉镜检查并录像,并行VSK检查获得声带前、中、后1/3特定位点的开放商(open quotient,OQ)数值,结合记波扫描图形分析VSK图像特征。结果 VSK图像中,正常对照组38例中8例(21.05%)声带后1/3相位轻微不对称,黏膜波稍减弱,其中2例(5.26%)后声门有裂隙,声带后1/3闭合相未见声门闭合;其余声带各位点相位均基本对称,黏膜波基本正常。声带麻痹组记录不到基频的17例(30.91%)无法得到可靠的OQ值。38例(69.09%)可以记录到基频的患者声带相位均极不对称,其中患侧声带可观察到黏膜波的18例(32.73%)中6例(10.91%)声带前1/3位点闭合相可观察到声门闭合,而声带中、后1/3位点闭合相未见声门闭合,双声带黏膜波减弱;患侧声带可观察到黏膜波的余12例(21.82%)及患侧声带观察不到黏膜波的20例(36.36%)患者VSK图像声带前、中、后1/3闭合相均未见声门闭合。记录到基频的38例声带麻痹患者声带前、中、后1/3位点OQ值分别为0.94±0.14、1.00±0.00、1.00±0.00,而正常对照组OQ值分别为0.55±0.10、0.64±0.13、0.60±0.17,声带麻痹组各位点的OQ值均明显大于正常对照组相对应的值,差异均有统计学意义(P<0.01)。结论 VSK能够直观观察声带麻痹患者声带某一位点振动的开放和闭合情况、相位对称性及黏膜波,是一种评价声带振动功能的有效检查方法。

Objective To explore the feasibility of videostrobokymography（VSK） for assessment of vocal cord vibration in patients with unilateral vocal cord paralysis（UVCP）.Methods 55 inpatients with advanced symptomatic UVCP for more than 6 months（UVCP group） were studied with videostroboscopy,38 out of these 55 inpatients whose stroboscopic videos were recorded with regular halogen light and 38 age and gender-matched normal persons（control group） were reviewed.Three lines at the anterior one-third,the middle third and the posterior one-third of the vocal cord were selected on corresponding kymograms.Values of open quotient（OQ） were obtained,together with kymograms to study the characteristics of VSK in UVCP group.Results In control group,phase symmetry on the posterior one-third of the vocal cord was slightly asymmetrical in 8 cases（21.05%） on corresponding kymograms,and mucosal waves were slightly attenuated.Slight gap of the posterior one-third of the vocal cord were observed in 2 cases（5.26%）,closures of glottal gaps were not observed at the posterior one-third of the vocal cord.Phase symmetry was symmetrical in the other cases.17 cases（30.91%） in UVCP group failed to trigger the stroboscope,resulting in the ambiguous corresponding kymogorams,and their values of OQ were not available.Phase symmetry was asymmetrical in 38 cases（69.09%） in UVCP group on corresponding kymograms.It included 18 cases（32.73%） which mucosal waves were observed in paralysed vocal cords,and closures of glottal gaps were observed on the anterior one-third but not on the middle third and the posterior one-third of the vocal cord in 6 cases（10.9%） out of those 18 cases.In addition,the mucosal waves were attenuated on bilateral vocal cords in those 18 cases.In other 12 cases（21.82%） with mucosal waves and 20 cases（36.4%） without mucosal waves on paralyzed vocal cords,closures of glottal gaps were not observed on the anterior one-third,the middle third and the posterior one-third of the vocal cord.In 38 cases（69.09%） in UVCP group,the mean and standard deviation of OQ on the anterior one-third,the middle third and the posterior one-third of the vocal cord were 0.94±0.14,1.00±0.00 and 1.00±0.00,respectively.In 38 cases in control group,the mean and standard deviation of OQ at the anterior one-third,the middle third and the posterior one-third of the vocal cord were 0.55±0.10,0.64±0.13 and 0.60±0.17,respectively.There were significant differences in values of OQ between these two groups（P0.01）.The values of OQ at the anterior one-third,the middle third and the posterior one-third of the vocal cord in UVCP group were bigger than those in control group.Conclusion The opening and closing conditions of vibration at one point on vocal cord,the phase symmetry and mucosal wave in VCP patients are all observed from VSK.VSK is an effective method for assessment of the vibratory patterns of vocal cords.