头颅定位侧位片与鼻咽纤维镜评价腭咽闭合不全的效果评价

A comparative study on the evaluation of velopharyngeal insufficiency with lateral cephalometric radiographs and nasopharynx fiberscope

目的:探讨头颅定位侧位片与鼻咽纤维镜对不同运动类型(冠状、矢状和环状)腭咽闭合不全判定的一致性以及头颅定位侧位片在判定腭咽闭合不全中的价值。方法:选择87例符合条件的腭裂术后患者,分别应用鼻咽纤维镜及头颅定位侧位片对其腭咽闭合情况进行测评,采用SPSS 13.0软件包对两者的测评结果进行配对t检验、Pearson相关分析以及Kappa一致性检验。结果:腭咽闭合不全率(RVPI)与腭咽矢状收缩不全率(RVSR)呈强正线性相关关系(Pearson相关系数0.695,P<0.01),其中冠状闭合与环状闭合组中两者呈强正线性相关关系(Pearson相关系数分别为0.678与0.728,P<0.01),矢状闭合组中两者的相关性不强(Pearson相关系数0.409,P>0.05)。2种评价方法对比,总体Kappa值为0.597,2种评价方法的一致性为中度。其中,冠状闭合组中,2种评价方法的对比结果 Kappa值为0.630;矢状闭合组中,2种评价方法的对比结果 Kappa值为0.667;环状闭合组中,2种评价方法的对比结果 Kappa值为0.534。结论:头颅定位侧位片是评价腭咽闭合功能的一种可靠方法,与鼻咽纤维镜评价腭咽闭合不全的吻合度为中等,且与闭合类型有关。头颅侧位片可作为腭咽闭合不全的筛查手段,在与主观测评不符时,需结合鼻咽纤维镜进行全面评估。

PURPOSE:To explore the consistency between lateral cephalometric radiographs and nasopharynx fiberscope in determination of velopharyngeal insufficiency of different types of motion(coronary,sagittal and annular),and the application of lateral cephalometric radiographs in determination of velopharyngeal insufficiency.METHODS:Eighty-seven eligible patients with palatoplasty were evaluated by nasopharynx fiberscope and lateral cephalometric radiographs respectively,and the results were analyzed by paired t test,Pearson’s correlation analysis and kappa consistency test with SPSS 13.0 software package.RESULTS:There was a strong positive linear correlation between rate of velopharyngeal insufficiency(RVPI)and rate of velopharyngeal sagittal restriction(RVSR)(Pearson’s correlation coefficient 0.695,P<0.01),in which there was a strong positive linear correlation between RVPI and RVSR in the coronary closure group and annular closure group(Pearson’s correlation coefficient 0.678 and 0.728,P<0.01),and a weak correlation between RVPI and RVSR in the sagittal closure group(Pearson’s correlation coefficient 0.409,P>0.05).The kappa value of the two evaluation methods was 0.597,and the consistency of the two evaluation methods is moderate;the kappa value of the two evaluation methods in the coronary closure group was 0.630,the kappa value of the two evaluation methods in the sagittal closure group was 0.667,and the kappa value of the two evaluation methods in the annular closure group was 0.534.CONCLUSIONS:Lateral cephalometric radiographs is a reliable method to evaluate velopharyngeal function,and the degree of anastomose with nasopharynx fiberscope method is moderate,which is related to the type of closure.Lateral cephalometric radiographs can be used as a screening method for velopharyngeal insufficiency in clinical practice.When it is inconsistent with subjective evaluation,it should be comprehensively evaluated with nasopharynx fiberscope.