张口仰头含牙颈部侧位片在预测困难支撑喉镜中的应用

Special lateral X-ray films of head and neck for prediction of difficult suspension laryngoscopy

目的评价张口仰头含牙颈部侧位片用于术前预测支撑喉镜手术声门暴露困难程度的应用价值。方法2010年10月至2012年2月纳入77例支撑喉镜下喉显微手术的患者,术前拍摄张口仰头含牙颈部侧位片,通过测量甲颏间距(mm)、舌颏间距(mm)、舌骨颏间距(mm)、舌甲颏距离(mm)、颏-舌-甲夹角()、上切牙长度(mm)、张口度(mm)、舌体厚度(mm)8个预测参数,与术中声门暴露困难度程度的视觉模拟评分法(visual analogue scale,VAS)作相关性分析,并选择有相关性的参数制定量表来评价张口仰头含牙颈部侧位片预测支撑喉镜声门暴露困难程度的可行性。结果多因素分析显示舌-甲颏距离(B=0.109,P=0.014)和上切牙长度(B=0.179,P=0.023)与喉镜手术声门暴露困难度程度的VAS主观评分之间存在正相关性;舌颏间距(B=-0.090,P=0.011)和张口度(B=-0.098,P=0.000)与喉镜手术声门暴露困难度程度的VAS主观评分之间存在负相关性。结论推荐患者在接受支撑喉镜手术前拍摄张口仰头含牙颈部侧位片以客观评估预测支撑喉镜声门暴露的困难程度。

Objective To evaluate the effectiveness of a special head and neck lateral X-ray on preoperative prediction for the difficulty of laryngeal exposure suspension larygoscopy. Methods From Oct. 2010 to Feb. 2012, 77 patients who underwent microlaryngosurgery were enrolled in this study. Preoperative lateral X-ray films of the head and neck were taken with the patient standing with head extended and mouth fully opened, 8 measurements including thyromental distance （mm）, thyrolingual distance （ram）, hyomental distance （ram）, vertical distance of hyoid bone to thyromental distance （ram）, thyrolingualmandihle angle （o）, upper incisor length （ram）, interincisor gap （ram） and thickness of tongue （ram） were made on each film, and compared with visual analogue scale, （VAS） score for difficulty of laryngeal exposure during the operation by the surgeon. A prediction scale was created based on the statistical results. Results Vertical distance from hyoid bone to thyromental distance （B = 0. 109 ,P = 0. 014） and upper incisor length （ B = 0. 179 ,P = 0. 023 ） were positively correlated with the VAS score for the difficulty of laryngeal expasure in suspension laryngoscopy. Hgomental distance （B = 0. 090,P = 0. 011） and interincisor gap （B = - 0. 098, P=0.000） were proved to be negatively correlated with the VAS score for the difficulty of laryngeal exposure in suspension laryngoscopy. Conclusions Preoperative measurement of special parameters on lateral X-ray films of head and neck may be useful for prediction of difficult laryngeal exposure in suspension laryngoscopy.