气管插管后环杓关节半脱位的诊断和治疗

Arytenoid Subluxation Following Endotracheal Intubation:Diagnosis and Treatment

目的 提高对气管插管后环杓关节半脱位 (AS)诊断和治疗的认识。方法 分析了 10例AS的症状、体征及电视频闪喉镜表现 ;所有患者均在表麻下行环杓关节拔动复位术 ,同时服用类固醇激素和阿斯匹林 2周。随访 2～ 6年。结果 患者症状为气管插管拔管后出现声嘶 ,检查可见声带固定 ,声带突高低不一 ,患侧声带振动存在。伤后 40天内就诊治疗 9例 ,拔动复位后杓部对称 ,声门闭合良好 ,嗓音恢复正常 ;1例伤后 4个月就诊者 ,多次拔动失败后 ,行甲状软骨板成形术Ⅰ型 ,嗓音得以改善。结论 病史及电视频闪喉镜检查可早期诊断AS。关节复位术是首选治疗方法。

Objective To improve the diagnosis and treatment of arytenoid subluxation(AS)following endotracheal intubation.Methods 10 cases with AS were analysed by symptoms,signs and strobovideolaryngoscopy.Closed reductions were applied in all cases under indirect laryngoscopy with local anesthesia.Stenoids and Aspirin were administered for 2 weeks after reduction. Following period was from 2 to 6 years.Results All cases had symptom of hoarseness immediately following extubation.Immobile vocal cords were also detected,and there was vibration of vocal cord in affected side.9 cases treated within 40 days of injury had symmetry of vocal processes and glottic closure after reduction and recovered normal voice,1 patient was treated by type I thyroplasty after failed reduction and her voice had improved. Conclusions Clinicd courses and strobovideolaryngoscopy could diagnose AS early.Closed reduction was the treatment of choice. Stenoid and Aspirin also had an important additional effect.