不同时间点行环杓关节拨动术治疗气管插管术后环杓关节脱位的疗效观察

Clinical observation of cricoarytenoid joint mobilization at different time points in the treatment of cricoarytenoid joint dislocation after tracheal intubation

目的探讨不同时间点于多功能纤维鼻咽喉镜下行环杓关节拨动术治疗环杓关节脱位的疗效。方法选取2010年1月至2020年10月首都医科大学附属北京康复医院耳鼻咽喉科收治的环杓关节前脱位患者32例,男12例,女20例,平均年龄47岁;左侧脱位21例,右侧脱位11例;脱位至就诊时间1~24 d,平均8.5 d。≤1周就诊20例,设为观察组;1周后就诊12例,设为对照组。均于多功能纤维鼻咽喉镜下行环杓关节拨动术,对脱位的环杓关节进行闭合复位治疗。结果32例患者中5例1次复位成功,12例2次复位成功,11例3次复位成功,2例复位不满意,2例复位失败。对照组治愈成功率为75.0%,观察组为95.0%。复位后,观察组复位次数低于对照组(P<0.05),复位后的G评分高于对照组(P<0.05),且患者满意度高于对照组(P<0.05)。结论多功能纤维鼻咽喉镜下行环杓关节拨动术治疗环杓关节前位损伤需尽早进行,尤其是1周以内进行复位,可提高疗效。

Objective To investigate the clinical effect of cricoarytenoid joint mobilization under multi-functional fiberoptic nasopharyngoscope at different time points on cricoarytenoid joint dislocation.Methods A total of 32 patients with anterior cricoarytenoid dislocation admitted to otolaryngology affiliated to Beijing Rehabilitation Hospital,12 males and 20 females,with an average age of 47 years old,21 cases of left dislocation and 11 cases of right dislocation.The course of disease ranged from 1-24 d,with an average of 8.5 d.Twenty cases within one week were enrolled in the observation group,12 cases after one week were in the control group.All the patients were treated with multi-functional fiber nasopharyngoscope for cricoarytenoid mobilization and closed reduction of dislocated cricoarytenoid joints.Results Among the 32 patients,five patients achieved after the first reduction,12 achieved after the second reduction,11 achieved after the third redution,two case were not satisfied with the reduction,and two cases failed.The success rate was 75.0%in the control group and 95.0%in the observation group.The times of reposition in the observation group were lower than those in the control group,the G score after reposition was higher than that in the control group,and the patients'satisfaction was higher than that in the control group.Conclusions The patients with arytenoid cartilage dislocation should accept arytenoid reduction under multi-functional fiberoptic nasopharyngoscope as soon as possible,especially within a week for reduction,can improve the curative effect.