动态CT扫描在探索声带麻痹患者喉部软组织三维动态变化中的应用价值

Application of dynamic CT scan in the three-dimensional dynamic morphology changes of laryngeal soft tissue in unilateral vocal fold paralysis patients

目的采用动态CT扫描探索声带麻痹患者喉部软组织三维形态的动态变化及应用价值。方法本研究为回顾性研究,选取2017年10月至2019年7月就诊于厦门大学附属中山医院耳鼻咽喉头颈外科二嗓音科的单侧声带麻痹患者18例(男10例,女8例,年龄29~75岁)和健康受试者10名(男5名,女5名,年龄25~58岁),行喉部动态CT Cine电影序列扫描,获得受试者从吸气到发音过程中喉部运动的10个动态序列影像,结合声门区面积和环状软骨位移的动态变化将获得的动态序列影像划分为吸气相和发音相、开相和闭相,分别测量各个相位声带长度、宽度、厚度和声带下方收敛角度。采用独立样本t检验分析单侧声带麻痹患者与健康受试者声带的三维形态参数。结果健康受试者从吸气到发音的过程中,吸气相和发音闭相声带形态相对稳定,发音开相和开闭相变换时,声带形态变化明显,长度变长(1.19±0.10)mm,宽度变宽(2.19±0.17)mm,厚度变薄(2.66±0.56)mm,声带下方收敛角度变小(31.45±4.78)°。声带麻痹组与健康受试组比较,开相时,声带麻痹组患侧声带的厚度比健康受试组薄(t=10.25,P<0.001),宽度较健康受试组大(t=5.25,P<0.001);闭相时,声带麻痹组患侧声带下方收敛角度较健康受试组大(t=4.41,P=0.001),健侧声带宽度比健康受试组大(t=2.54,P=0.026),其他参数比较差异无统计学意义。结论喉部动态CT扫描为吸气到发音过程中喉部软组织三维形态动态变化的客观定量测量提供了一种简便、无创的方法。吸气到发音过程中,失神经支配的单侧声带麻痹患者的声带下方收敛角度与声带厚度较健康受试组发生特征性的动态变化。闭相时健侧声带的宽度可用于评估其代偿功能。

Objective To explore the dynamic changes of three-dimensional morphology of laryngeal soft tissue and its clinical value in the unilateral vocal fold paralysis(UVFP)patients through dynamic CT scanning during the process from inspiration to phonation.Methods From October 2017 to July 2019,a retrospective study was performed in 18 patients with UVFP(10 males and 8 females with the range of age from 29 to 75 years old)and 10 normal subjects(5 males and 5 females with the range of age from 25 to 58 years old)in Department of Voice-Otolaryngology Head and Neck Surgery,Section Two,Zhongshan Hospital Xiamen University.The laryngeal dynamic computed tomography(CT)of cine mode was performed.Ten dynamic sequence images of vocal folds movements were obtained during the process from inspiration to phonation.Based on the dynamic changes of glottic area and the displacement of cricoid cartilage.The above dynamic sequence images were divided into inspiratory phase and phonation phase as well as open phase and closed phase.The soft tissue parameters were measured respectively,including vocal folds length,width,thickness and subglottal convergence angle.Independent-sample t test was used to analyze between UVFP group and control group.Results During the process from inspiration to phonation,the morphology of vocal folds in control group was relatively stable at inspiratory phase and closed phase in phonation.When open phase and closed phase of phonation were switching,the morphology of vocal folds changed obviously.The length of vocal folds became longer(1.19±0.10)mm,the width became wider(2.19±0.17)mm,the thickness became thinner(2.66±0.56)mm,and the subglottal convergence angle decreased(31.45±4.78)°.Compared with the controll group,in the open phase,the thickness and width of the vocal fold on affected side in the UVFP group were thinner(t=10.25,P<0.001)and wider(t=5.25,P<0.001).While in the closed phase,the subglottal convergence angle was larger(t=4.41,P=0.001).The width of the healthy side vocal fold in the UVFP was wider(t=2.54,P=0.026)than that in the control group.The differences in other parameters were not statistically significant.Conclusions Dynamic laryngeal CT scanning provides a simple and non-invasive method for the objective and quantitative measurement of the dynamic changes of laryngeal morphology from inspiration to phonation.Compared with the control group,the characteristic dynamic changes among UVFP were observed during this particular process,which included changes of subglottal convergence angle and thickness of vocal muscle due to denervation.In addition,in UVFP group,the width of the vocal fold healthy side in the closed phase may be used to assess its compensatory function.