三维CT诊断环杓关节脱位的价值

Value of three-dimensional CT in the diagnosis of cricoarytenoid dislocation

目的探讨三维CT诊断环杓关节脱位的价值。方法回顾性收集2021年1月至12月在南京医科大学附属明基医院经夹持式环杓关节复位术治疗、嗓音恢复或明显改善的31例单侧环杓关节脱位患者,对其术前CT图像进行容积重建(VR)。观察环杓关节脱位的侧别(左、右侧)、类型(全脱位和半脱位)和方向(前、后、内、外脱位)。根据杓状软骨移位致环状软骨杓关节面有无完全暴露将其分为全脱位和半脱位,根据杓状软骨移位及环状软骨杓关节面暴露的方位将其分为前、后、内、外脱位。根据喉镜上声带的形态进行脱位前、后方向的判断,并与CT判断结果进行比较。结果VR图像显示环杓关节半脱位28例(90.3%,28/31),全脱位3例(9.7%,3/31)。左侧环杓关节脱位26例(83.9%,26/31),右侧脱位5例(16.1%,5/31)。后脱位28例(90.3%,28/31),前脱位3例(9.7%,3/31)。内侧脱位23例(74.2%,23/31),外侧脱位2例(6.4%,2/31),无明显内外方向脱位6例(19.4%,6/31)。3例全脱位均为左侧后内脱位。左后脱位24例(77.4%,24/31),右后脱位4例(12.9%,4/31),左前脱位2例(6.4%,2/31),右前脱位1例(3.2%,1/31)。喉镜显示环杓关节后脱位19例(61.3%,19/31),前脱位9例(29.0%,9/31),3例因杓部遮挡难以评估(9.7%,3/31)。喉镜显示的环杓关节前、后方向脱位与三维CT相符16例(55.2%,16/28),不相符12例(42.8%,12/28)。结论三维CT是评估环杓关节脱位的可靠检查方法,可清晰显示环杓关节的脱位侧别、脱位类型和脱位方向。

Objective To investigate the value of three-dimensional(3D)CT in diagnosing cricoarytenoid dislocation.Methods From January 2021 to December 2021,31 patients with unilateral cricoarytenoid dislocation who had been treated by reduction forceps at the Affiliated BenQ Hospital of Nanjing Medical University were collected retrospectively,and their voice recovered or improved significantly after therapy.The preoperative CT images were reconstructed by volume rendering(VR).The dislocated side(left and right),type of dislocation(total dislocation and subluxation),and dislocation direction(anterior,posterior,internal and external dislocation)of cricoarytenoid dislocation were observed.According to arytenoid articular surface of cricoid cartilage exposed completely or not(caused by arytenoid displacement),they were divided into complete dislocation and subluxation.According to the direction of arytenoid displacement and the part of arytenoid articular surface of cricoid cartilage exposed,they were divided into anterior,posterior,internal and external dislocation.According to the shape of the vocal cords on laryngoscope,anterior and posterior dislocation of each case was judged,and then compared with that of CT.Results On VR images,there were 28 cases of cricoarytenoid subluxation(90.3%,28/31)and 3 cases of complete dislocation(9.7%,3/31).Left cricoarytenoid dislocation was 26 cases(83.9%,26/31)and right cricoarytenoid dislocation was 5 cases(16.1%,5/31).Posterior dislocation was 28 cases(90.3%,28/31)and anterior dislocation was 3 cases(9.7%,3/31).There were 23 cases of internal dislocation(74.2%,23/31),2 cases of external dislocation(6.4%,2/31),and 6 cases without obvious internal and external dislocation(19.4%,6/31).Three cases of complete dislocation were left posterior internal dislocation.There were 24 cases of left posterior dislocation(77.4%,24/31),4 cases of right posterior dislocation(12.9%,4/31),2 cases of left anterior dislocation(6.4%,2/31)and 1 case of right anterior dislocation(3.2%,1/31).On laryngoscope,there were 19 cases of posterior dislocation(61.3%,19/31),9 cases of anterior dislocation(29.0%,9/31),3 cases were difficult to assess(9.7%,3/31)because of aryepiglottic fold covering.Sixteen cases(55.2%,16/28)were consistent with 3D CT,and 12 cases(42.8%,12/28)were inconsistent.Conclusion The 3D CT is a reliable method to evaluate cricoarytenoid dislocation,which can show dislocated side,type and direction of cricoarytenoid dislocation clearly.