静脉麻醉可视喉镜下夹持式环杓关节复位技术临床报告

Clinical report of hoding cricoarytenoid joint reduction with visual laryngoscope under intravenous anesthesia

目的探讨静脉麻醉可视喉镜下夹持式环杓关节复位技术的复位效果。方法回顾性分析2020年1月至2021年9月南京医科大学附属明基医院连续收治的环杓关节脱位行闭合复位治疗的40例患者临床资料,男21例,女19例,年龄17~82(中位年龄48)岁。对环杓关节脱位的诱因、患者症状、术前评估方法、复位操作技术、复位次数以及复位后杓状软骨运动及声音恢复情况进行评价和分析。结果所有患者在接受治疗前均有明显声音嘶哑,发声明显气息声;频闪喉镜或电子纤维喉镜下可见患侧声带运动障碍及声门闭合不良,其中左侧28例,右侧9例,双侧3例。麻醉插管25例(62.5%),为脱位最常见原因,其他依次为喉部外伤、无痛胃镜检查、剧烈咳嗽、呕吐等。其中我科初诊复位28例,外院复位失败来诊12例。40例患者中脱位后24 h行复位6例;3 d~1个月18例;1~3个月7例;3~6个月复位6例;6个月以上3例。复位1次后发音恢复正常10例(10/40,25%),2次复位后恢复正常14例(14/40,35%),3次后正常10例(10/40,25%),4次后正常2例(2/40,5%),5次后正常1例(2.5%)。采用喉部薄层CT扫描加环杓关节重建进行分类:半脱位37例(92.5%)、3例全脱位;28例左侧脱位,9例右侧,双侧3例;29例(72.5%)后脱位、11例(27.5%)前脱位。所有患者经静脉麻醉可视喉镜下、专用复位钳夹持杓状软骨进行复位。术后禁声1~2周,术后第1周和第4周经频闪喉镜和/或嗓音分析评估疗效,声带运动恢复正常、发音良好37例(92.5%)。结论静脉麻醉可视喉镜下夹持式环杓关节复位技术便于操作,复位效果稳定,是环杓关节复位的可靠方法。

Objective To investigate the reduction effect of hoding cricoarytenoid joint reduction with visual laryngoscope under intravenous anesthesia.Methods The therapeutic effects of 40 patients with arytenoid dislocation(AD)treated by closed reduction in the single center from January 2020 to September 2021 were retrospectively analyzed,including 21 males and 19 females,median age 48 years.The etiology,symptoms,preoperative evaluation methods,reduction mode,reduction times,and the recovery of arytenoid cartilage movement and sound after reduction were evaluated and analyzed.Results All patients had obvious hoarseness and breath sound before treatment.Under stroboscopic laryngoscope or electronic nasopharyngoscope,different degrees of vocal cord movement disorder and poor glottic closure can be seen.There were 28 cases of left dislocation,9 cases of right dislocation and 3 cases of bilateral dislocation.The etiology of dislocation of cricoarytenoid joint:25 cases(62.5%)of tracheal intubation under general anesthesia were the most common causes,was as follows by laryngeal trauma,gastroscopy,cough,vomiting and so on.Among them,28 cases of reduction were initially diagnosed in our department,and 12 cases were diagnosed later after failure of reduction treatment.Of the 40 patients,6 underwent reduction 24 hours after dislocation;18 cases from 3 days to 1 month;7 cases from 1 to 3 months;6 cases were reset in 3~6 months;Over 6 months in 3 cases.After one reduction,10 cases(10/40,25%)recovered normal pronunciation,14 cases(14/40,35%)recovered normal pronunciation after two reduction,10 cases(10/40,25%)recovered normal pronunciation after three times,2 cases(2/40,5%)recovered normal pronunciation after four times,and 1 case(2.5%)recovered normal pronunciation after five times.Thin slice CT scan of larynx and cricoarytenoid joint reconstruction showed the types of AD:subluxation in 37 cases(92.5%)and total dislocation in 3 cases;28 cases of left dislocation,9 cases of right dislocation and 3 cases of bilateral dislocation;29 cases(72.5%)had posterior dislocation and 11 cases(27.5%)had anterior dislocation.All patients were treated by intravenous anesthesia with arytenoid cartilage clamped by cricoarytenoid joint reduction forceps under visual laryngoscope.The curative effect was evaluated by stroboscopic laryngoscope and/or voice analysis at 1-2 weeks after operation.The vocal cord movement returned to normal and the pronunciation was good in 37 cases(92.5%).Conclusions Hoding cricoarytenoid joint reduction with the vision laryngoscope under intravenous anesthesia is easy to operate and the reduction effect is more stable.It is a effective method for AD.