无联带运动的单侧声带麻痹及联带运动性再支配的IV型声带麻痹患者行I型甲状软骨成形术后转归更佳
Better Outcome After Thyroplasty Type I in Unilateral Vocal Fold Paralysis Without Synkinesis and Synkinetically-Reinnervated Type IV Vocal Fold Paralysis.
文献信息
| PMID | 42921744 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Annabella Kurz |
| 作者单位 | Department of Otorhinolaryngology, Medical University of Vienna, Austria. |
| 期刊 | Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale |
| SCI 分区 | Q1 |
| IF | 2.7 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
重要性： I型甲状软骨成形术被视为慢性单侧声带麻痹（UVFP）患者的标准治疗；常需修正手术。
目的： 本研究旨在探讨联带运动是否影响I型甲状软骨成形术。
设计： 回顾性数据分析。
参与者： I型甲状软骨成形术后的UVFP患者（年龄≥18岁）。暴露干预：2019年11月至2022年11月间，28例慢性UVFP患者接受I型甲状软骨成形术，并于术后6个月随访。术前所有患者均接受喉肌电图（LEMG）检查。
主要结局指标： 术前及I型甲状软骨成形术后至6个月评估发声障碍严重指数（DSI）、感知嗓音分析（GRBAS）、嗓音声学（jitter%）、最长发声时间（MPT）、嗓音范围剖面测量（VRP）、嗓音障碍指数（VHI-9）及喉（频闪）镜所见。为研究目的，根据术前数据回顾性评估联带运动的存在，并按Crumley分类进行分型。统计分析为探索性。采用线性混合效应模型评估有和无联带运动患者的术前和术后DSI。统计分析使用SPSS 27版进行。
结果： 16例患者为无联带运动的UVFP，12例伴联带运动。伴联带运动患者中，25%分类为Crumley II型，50%为IV型，25%为未定义型。所有患者术后DSI显著改善（P=.006）。GRBAS评分、MPT和Jitter（%）的最大改善见于IV型及无联带运动的UVFP患者。VHI-9评分在IV型联带运动患者（n=6）和无联带运动患者（n=16）中改善。大多数伴联带运动（n=7）和不伴联带运动（n=12）的患者实现完全声门闭合。
结论： 本研究强调在I型甲状软骨成形术前对慢性UVFP进行术前LEMG以识别不利联带运动类型的重要性，因为常规喉（频闪）镜和嗓音声学评估无法对异常再支配过程作出任何结论。
相关性： IV型患者适合接受I型甲状软骨成形术。在II型和未定义型联带运动中，单纯I型甲状软骨成形术不足，应考虑附加治疗。
英文摘要
IMPORTANCE: Thyroplasty type I is considered standard therapy in patients with chronic unilateral vocal fold paralysis (UVFP); revisions are frequently required.
OBJECTIVE: The aim of the study was whether synkinesis affects thyroplasty type I.
DESIGN: Retrospective data analysis.
PARTICIPANTS: Patients with UVFP (age ≥18 years) after thyroplasty type I.Intervention of exposures: Between November 2019 and November 2022, 28 patients with chronic UVFP underwent thyroplasty type I and were followed up 6 months postoperatively. Prior to surgery, all patients underwent laryngeal electromyography (LEMG).
MAIN OUTCOME MEASURES: Dysphonia Severity Index (DSI), perceptual voice sound analysis (GRBAS), voice acoustics (jitter %), maximum phonation time (MPT), voice range profile measurements (VRP), Voice Handicap Index (VHI-9), and laryngo(strobo)scopic findings were assessed preoperatively and up to 6 months after thyroplasty. For study purposes, the presence of synkinesis was retrospectively evaluated and classified according to the Crumley classification based on preoperative data. Statistical analyses were exploratory. A linear mixed-effects model was used to asses preoperative and postoperative DSI in patients with and without synkinesis. Statistical analyses were carried out with SPSS version 27.
RESULTS: Sixteen patients had a UVFP without and 12 with synkinesis. Among patients with synkinesis, 25% were classified as Crumley type II, 50% as type IV, and 25% as undefined. DSI improved significantly postoperatively across all patients (P = .006). The greatest improvement in GRBAS score, MPT, and Jitter (%) were observed in UVFP patients with type IV and those without synkinesis. VHI-9 scores improved in patients with type IV synkinesis (n = 6) and those without synkinesis (n = 16). Complete glottal closure was achieved in most patients with (n = 7) and without synkinesis (n = 12).
CONCLUSION: This study emphasizes the importance of preoperative LEMG in chronic UVFP before thyroplasty type I to identify unfavorable synkinesis types, as routine laryngo(strobe)scopy and voice acoustic evaluation do not allow any conclusion on aberrant reinnervation processes.
RELEVANCE: Patients with type IV are suitable candidates for thyroplasty type I. In type II and undefined synkinesis, thyroplasty type I alone is insufficient, and additional therapies should be considered.