Analysis of vocal fold movement characteristics in patients with laryngeal neurogenic injury
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摘要: 目的 分析喉肌神经源性损伤患者的声带运动及声门闭合特点。方法 入选经喉肌电图确诊为环甲肌、甲杓肌及环杓后肌为神经源性损害的患者185例，分别按侧边分为单侧声带麻痹组及双侧声带麻痹组，按神经损伤分为喉上神经麻痹组、喉返神经麻痹组及迷走神经麻痹组。频闪喉镜下分析声带运动特点及声门闭合情况，声带运动定性评估为声带固定、声带运动减弱及声带运动正常，声门闭合定性评估为声门闭合及声门闭合不全。对结果进行统计学分析。结果 双侧声带麻痹组声带运动正常、运动减弱及固定的构成比与单侧声带麻痹组间的差异有统计学意义(P < 0.05)，双侧声带麻痹组的声带运动正常及运动减弱的构成(47.70%)显著大于单侧声带麻痹组(12.27%)。双侧声带麻痹组声门闭合与声门闭合不全的构成比与单侧声带麻痹间的差异无统计学意义(P>0.05)。喉上神经麻痹组声带运动减弱的构成比(50.00%)大于喉返神经麻痹组(9.32%)及迷走神经麻痹组(9.00%)，声带运动减弱、固定的构成比在喉上神经麻痹组、喉返神经麻痹组与迷走神经麻痹组间的差异有统计学意义(P < 0.05)；3组间声门闭合情况比较差异无统计学意义(P>0.05)。结论 喉肌神经源性损伤患者的声带运动特征以声带固定为主，也可为声带运动正常及声带运动减弱，单侧声带麻痹在临床上可能存在漏诊；有50%的喉上神经麻痹患者的声带运动特征为声带固定。Abstract: Objective To analyze the characteristics of vocal fold movement and glottic closure in patients with laryngeal neurogenic injury.Methods A total of 185 patients with vocal fold paralysis diagnosed by laryngeal electromyography as neurogenic damage to cricothyroid muscle, thyreoarytenoid muscle and posterior cricoarytenoid muscle were enrolled, they were divided into unilateral vocal fold paralysis group and bilateral vocal fold paralysis group, respectively, and superior laryngeal paralysis group, recurrent laryngeal nerve paralysis group and vagal nerve paralysis group according to nerve injury. The characteristics of vocal fold movement and glottic closure were analyzed under strobe laryngoscope. The qualitative evaluation of vocal fold movement was fixed vocal fold, reduced vocal fold movement and normal vocal fold movement, and the qualitative evaluation of glottic closure was glottic closure and glottic imperfection. The results were analyzed statistically.Results The proportion of normal, reduced and fixed vocal fold motion in bilateral vocal fold paralysis group was significantly different from that in unilateral vocal fold paralysis group(P < 0.05), the composition of normal and reduced vocal fold motion in bilateral vocal fold paralysis group(47.70%) was significantly greater than that in unilateral vocal fold paralysis group(12.27%). There was no significant difference between the proportion of glottic closure and glottic imperfecta in bilateral vocal fold paralysis group and unilateral vocal fold paralysis group(P < 0.05). The proportion of decreased vocal fold motion in superior laryngeal nerve paralysis group(50.00%) was higher than that in recurrent laryngeal nerve paralysis group(9.32%) and vagal nerve paralysis group(9.00%). The proportion of decreased and fixed vocal fold motion in superior laryngeal nerve paralysis group, recurrent laryngeal nerve paralysis group and vagal nerve paralysis group was statistically significant(P < 0.05).There was no significant difference in glottic closure among the three groups(P < 0.05).Conclusion Vocal fold movement characteristics of patients with laryngeal neurogenic injury were mainly vocal fold fixation, or normal or weakened vocal fold movement. There may be missed diagnosis of unilateral vocal fold paralysis in clinical practice. In half of the patients with superior laryngeal nerve palsy, vocal fold movement is characterized by vocal fold fixation.
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Key words:
- vocal fold paralysis /
- laryngeal nerve /
- vocal fold movement
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表 1 双侧声带麻痹患者病史、喉肌电图及声带运动情况表
例序 性别 年龄/岁 病史 左侧喉肌肌电图 左侧声带运动情况 右侧喉肌肌电图 右侧声带运动情况 1 女 54 甲状腺癌术后声嘶1个月 环甲肌、甲杓肌环杓后肌神经源性损害 声带固定 环甲肌、甲杓肌及环杓后肌神经源性损害 声带固定 2 男 46 食道癌术后声嘶3个月 甲杓肌神经源性损害 运动正常 环甲肌、甲杓肌、环杓后肌神经源性损害 声带固定 3 女 64 感冒后声嘶2个月 环甲肌神经源性损害 运动正常 环甲肌神经源性损害 运动减弱 4 女 39 甲状腺癌术后声嘶3个月 环杓后肌神经源性损害 运动减弱 甲杓肌神经源性损害 运动正常 5 女 51 乳腺癌肺部转移，声嘶2周 环杓后肌神经源性损害 运动减弱 甲杓肌、环杓后肌神经源性损害 运动减弱 6 女 26 甲状腺癌术后声嘶1个月 环甲肌、甲杓肌及环杓后肌神经源性损害 声带固定 环甲肌、环杓后肌神经源性损害 运动正常 7 男 37 病因不明声嘶3个月 甲杓肌及环杓后肌神经源性损害 运动正常 甲杓肌神经源性损害 运动减弱 8 女 38 甲状腺癌术后声嘶1个月 甲杓肌及环杓后肌神经源性损害 声带固定 甲杓肌神经源性损害 声带固定 9 男 37 病因不明声嘶15 d 甲杓肌及环杓后肌神经源性损害 声带固定 环甲肌、甲杓肌及环杓后肌神经源性损害 运动减弱 10 男 68 病因不明声嘶2个月 甲杓肌及环杓后肌神经源性损害 声带减弱 甲杓肌及环杓后肌神经源性损害 声带固定 11 男 45 甲状腺癌术后声嘶11个月 甲杓肌神经源性损害 声带固定 环甲肌、甲杓肌及环杓后肌神经源性损害 声带固定 12 男 42 甲状腺癌术后声嘶1个月 环甲肌、环杓后肌神经源性损害 声带固定 环甲肌、环杓后肌神经源性损害 运动正常 13 男 39 病因不全声嘶4个月 环甲肌、甲杓肌神经源性损害 运动减弱 环甲肌、甲杓肌及环杓后肌神经源性损害 声带固定 14 男 45 病因不全声嘶6个月 环甲肌、甲杓肌神经源性损害 运动减弱 环甲肌神经源性损害 运动减弱 15 女 36 甲状腺癌术后2周 环甲肌、甲杓肌神经源性损害 声带固定 环甲肌、甲杓肌神经源性损害 声带固定 16 男 70 食道癌术后1个月 甲杓肌及环杓后肌神经源性损害 声带固定 环甲肌、甲杓肌及环杓后肌神经源性损害 声带固定 17 男 16 溺水心肺复苏后1个月 环甲肌、甲杓肌神经源性损害 运动减弱 环甲肌、甲杓肌及环杓后肌神经源性损害 声带固定 18 女 53 甲状腺癌术后2个月 甲杓肌及环杓后肌神经源性损害 运动减弱 甲杓肌及环杓后肌神经源性损害 声带固定 19 女 58 甲状腺癌术后声嘶2周 甲杓肌及环杓后肌神经源性损害 声带固定 甲杓肌及环杓后肌神经源性损害 声带固定 20 女 29 病因不明声嘶5个月 环甲肌神经源性损害 运动正常 环甲肌神经源性损害 运动减弱 21 男 67 病因不全声嘶7个月 环甲肌、甲杓肌及环杓后肌神经源性损害 声带固定 甲杓肌神经源性损害 运动正常 22 男 65 食道癌术后声嘶1个月 甲杓肌及环杓后肌神经源性损害 声带固定 环甲肌、甲杓肌神经源性损害 声带固定 
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表 2 单侧声带麻痹与双侧声带麻痹患者声带运动及声门闭合情况的比较
声带麻痹侧别 例数 侧数 声带/侧(%) 声门闭合患者/例(%) 运动正常 运动减弱 固定 声门闭合 声门闭合不全 单侧 163 163 0 20(12.27) 143(87.73) 16(9.82) 147(90.18) 双侧 22 44 8(18.20) 13(29.50) 23(52.30) 2(9.10) 20(90.90) χ2 36.64 0.01 P < 0.01 0.91
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表 3 喉上、喉返与迷走神经麻痹患者声带运动及声门闭合情况的比较
声带麻痹侧别 例数 侧数 声带/侧(%) 声门闭合/例(%) 运动正常 运动减弱 固定 声门闭合 声门闭合不全 喉上神经麻痹 12 12 0 6(50.00) 6(50.00) 0 12(100.00) 喉返神经麻痹 118 118 0 11(9.32) 107(90.68) 10(8.47) 108(91.53) 迷走神经麻痹 33 33 0 3(9.09) 30(90.91) 5(15.15) 28(84.85) χ2 9.517 1.374 P 0.009 0.503
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