“蛇口”复位钳杓状软骨复位术治疗环杓关节脱位的临床分析

Clinical analysis of arytenoid cartilage reposition with snake mouth forceps for the arytenoid cartilage dislocation

目的:探讨静脉全身麻醉下"蛇口"复位钳杓状软骨复位术治疗环杓关节脱位的临床疗效。方法:分析2013-05-2017-11期间26例环杓关节脱位接受静脉全身麻醉下杓状软骨复位术的患者资料,其中全身麻醉气管插管导致23例,喉部外伤3例。19例术前行喉部螺旋CT扫描及环杓关节重建,所有患者均行喉内肌肌电图检查。静脉全身麻醉下,以特制"蛇口"复位钳在可视喉镜直视下,根据喉镜及CT提示的脱位方位进行复位,手术结束时双侧杓状软骨仍不对称者1周后重复复位1~2次,术后进行发声训练。术后4周评价疗效。结果:患者术前均有声音嘶哑,发声气息声明显。喉镜下均见不同程度的声带运动障碍,其中22例为左侧,4例为右侧;均伴有声门闭合不良;杓状软骨向前内侧移位者25例,向后外侧移位者1例。CT显示15例杓状软骨向前向内移位,伴有环杓关节间隙不同程度的增宽。4例轴位CT图像未发现杓状软骨脱位的直接征象,但在冠状位和矢状位重建及环杓关节重建图像上可见位置异常杓状软骨。喉肌电图提示7例异常,可见失神经电位,募集电位呈混合相。术后第1天嗓音恢复正常者4例,经2次复位成功者19例,3次复位成功3例。术后4周患者自述声音均恢复正常,吞咽疼痛、饮水呛咳均消失;喉镜检查声带运动恢复正常25例(96.2%);1例颈部勒伤后32天复位者声带运动较健侧稍差,但较术前明显改善。结论:静脉全身麻醉下"蛇口"复位钳杓状软骨复位是治疗环杓关节脱位的有效方法。

Objective：To investigate the clinical effect of the arytenoid cartilage reposition using snake mouth reduction forceps under general anesthesia.Method：Data of twenty-six cases accepted arytenoid cartilage reposition under intravenous general anesthesia were analyzed,nineteen cases accepted laryngeal CT scan and cricoarytenoid joint reconstruction,all patients underwent endolaryngeal muscle electromyography examination.According to the position of cartilage dislocation prompted by laryngoscope and CT,the arytenoid cartilage was repositoned under the visual laryngoscope using special snake mouth reduction forceps.If bilateral arytenoid cartilage were still asymmetrically at the end of the surgery,patients needed repeated reposition 1 to 2 times 1 week after operation.The efficacy was evaluated 4 weeks later.Result：All patients had a hoarse and breathing voice preoperative.Under laryngoscope,there were different degrees of vocal cord movement disorders accompanied by incomplete glottis closure,22 cases happened in left side and 4 in right side.The arytenoid cartilage was dislocated anteromedially in25 cases and posterolaterally in 1 case.CT showed that 15 cases of arytenoid cartilage were tilted anteromedially,the interval of the cricoarytenoid joint was widened.In axial CT images,there were no direct signs of the arytenoid cartilage dislocation in the 4 cases,but the abnormal position was seen in the reconstruction images.The laryngeal electromyography indicated that 7 cases were abnormal,duration of motor unit potential were visible and the raising potential were mixed.There were 4 patients with normal voice in the first day after surgery,and 19 cases underwent twice and 3 cases underwent three times surgery.Vioce became normal in 4 weeks.Swallowing pain and bucking were all disappeared.Vocal cords movement were recovered to normal level in 25 cases.In 1 case with neck strangulation,the vocal cord movement was slightly worse than health side,but significantly better than that before operation.Conclusion：The arytenoid cartilage reposition using snake mouth reduction forceps under general anesthesia was an effective method for the treatment of the cricoary-tenoid joint dislocation.