声带振动功能的无创检测

检测６０例正常人和２０例单侧声带麻痹患者的ＥＧＧ参数ＣＱ、ＣＩ和声学参数ＮＮＥ，并进行统计分析。结果显示：正常人声门闭合较完全，声门接触相中，逐渐关闭的过程快于逐渐张开的过程（ＣＩ为负数）。麻痹患者声门闭合程度下降（ＮＮＥ增大），声门闭合过程中断触相时程延长（ＣＩ增大）。麻痹组与正常组间ＣＱ值无显著性差异。提示ＥＧＧ和ＮＮＥ的无创测试可用来分析声带振动功能；单侧声带麻痹后声带振动模式出现病理性发迹     

单侧声带麻痹的电声门图测试

为探讨单侧声带麻痹患者的声带振动规律,文中对46例患者作了电声门图(electroglottograph,EGG)测试,将参数接触率(contact quotient,CQ)、接触率微扰(contact quotient perturbation,CQP).接触幂(contact index,CI)和接触幂微扰(contact index perturbation,CIP)与声带固定的位置相结合进行统计学分析,结果为多数单侧声带麻痹患者EGG参数异常,包括CQ减少,Cl、CQP及CIP增大.其中,声带固定在正中位组EGG各参数正常率高于旁正中位组,CQ异常率旁正中位组高于正中位组,中间位组EGG各参数均异常,声带固定的位置不同,CI及CQP、CIP无显著性差异.因EGG能描记每一振动周期特点,对研究缺乏规律性的声带振动,有一定的应用前景.     

动态喉镜图像定量分析技术的应用

目的探索图像定量分析技术在声带振动研究中的应用。方法应用计算机软件、分析６０例正常人和２０例单侧声带麻痹患者的动态喉镜图像。结果正常组声带振动均呈规律性,多数声门闭合完全;麻痹组声带振动均不规律,多数声门闭合不全,发声相声门最小面积（Ａｍｉｎ）麻痹组明显大于正常组,而最大面积（Ａｍａｘ）两组间无显著性差异。结论动态喉镜计算机图像分析技术可用于声带振动功能的定量分析。     

声带小结者嗓音分析和电声门图参数变化的比较

目的比较分析声带小结者嗓音参数和电声门图（EGG）参数的变化，评价这些参数在该病的诊断和疗效观察中的意义。方法采用Dr．SpeechScienceforWindows软件对42例未经手术的声带小给患者作嗓音分析和EGG检测，对其主要声学参数变化进行比较，并对声带小结的EGG波形作了观察。结果在声带小结的诊断中，两种方法中的声学参数基音频率微扰（jitter）和基音振幅微扰（shimmer）均是有价值的，二者可以相互替代。EGG的标准声门噪声能量（NNE）特异性高，嗓音分析中的NNE则敏感性高。结论EGG中声门波的特征结合嗓音分析及EGG的jitter和shimmer值对声带小结的诊断和疗效观察有较大的意义。     

计算机图像处理技术对声门图像参数的检测及临床意义

目的：探讨计算机图像处理技术测量正常和病理状态下的声门图像参数及其临床意义,方法：用该技术测量６０例正常成人,６０例声带息肉和４０例单侧声带麻痹患者的声门图像参数,并进行统计分析,结果：正常人声门最小面积〉０,且女性的相对值大于男性,绝对值相近;声门最大面积的相对值两性相近,绝对值则是男性大于女性,声带息肉患者较正常人声门最小面积增大,声带麻痹患者声门最小面积增大,最大面积减小,结论：将该技术结合喉镜检查,可对喉部图像进行定量分析,淡声带息肉和声带麻痹患者的诊治提供更客观、更精确的依据。     

声带良性病变的电声门图波形特征和参数分析

目的 :探讨电声门图 (EGG)在声带良性病变中测试的敏感性、特异性及其临床应用价值。方法 :对36 5例显微喉镜手术前后的声带息肉、声带囊肿和声带白斑患者进行EGG测试 ,分析其波形和参数。结果 :声带息肉、囊肿和白斑患者术前EGG波形多数异常 ,尤以波形呈单一固定的切迹或渐开相陡直为主 ,术后波形多数转为正常 ,每组患者手术前后EGG波形间差异均有极显著性 ,而不同病变之间EGG波形无差异。声带息肉和囊肿间EGG参数值无差异 ,而白斑患者接触率 (CQ)值相对较低 ,接触幂 (CI)相对较高。显微喉镜术后 ,息肉和囊肿患者EGG参数基频微扰 (jitter)、振幅微扰 (shimmer)、谐噪比 (HNR)、CQ和接触微扰 (CQP)改善 ,而白斑患者仅HNR提高。结论 :EGG波形在声带良性病变的检测中具有一定的灵敏度 ,而无特异性 ,其参数值受局部病灶和声带内在炎症的影响。     

声带下方收敛角度在声门闭合不全发声困难中可能的作用机理

目的 探讨喉三维CT重建下声带下方收敛角度的测量方法,探索声门闭合不全对声带下方收敛角度的影响,分析声门闭合不全发声疲劳可能的气流动力学原因.方法 采用双源薄层CT,嘱受试者发/i:/音时扫描10例正常人的20侧声带(声门闭合组),深吸气时扫描8例单侧声带麻痹患者的麻痹侧声带(声门闭合不全组),经深吸气时扫描另10例正常人的20侧声带(声带外展组);导入影像数据于Mimics软件,构建声带及气道的3D模型,联合这两模型测量声带下方收敛角度;采用单因素方差分析,比较3组受试者声带下方收敛角度的差异;并尝试采用材料的斜截面应力分配原理进行声门下压力分析,探讨声门下收敛角度对启动发声时声带振动可能的影响.结果 声门闭合组、声门闭合不全组及声带外展组的声带下方收敛角度分别为33.49°±3.75°、55.03°±2.61°及75.02°±7.32°,三组间差异有统计学意义(P<0.01),声带下方收敛角度随声门闭合不全程度增加而增加.结论 声带下方收敛角度可以通过声带及气道的3D模型进行有效测量,声门闭合不全程度增加会引起该角度增大,可能会导致声门下压力作用于声带下方的剪切力和正应力的分力发生变化,从而引起发声困难.     

声带注射在矫正声门闭合不全中的应用

声门闭合不全导致的发声困难和误吸等症状影响到患者的生存质量，甚至对生命造成潜在的威胁。单侧声带麻痹是引起声门闭会不全的最常见原因。目前治疗单侧声带麻痹的方法主要有以下几种：（1）喉结构外科（laryngealframeworksurgery）（2）神经再支配术（reinnervation）（3）电起搏治疗（electricalpacing）（4）声带注射术（injectionlampgopasty）。其中，声带注射术相对而言有着实用、简便、安全、经济的优越性，被广泛应用于声门闭会不全的矫治。除单侧声带麻痹外，声带注射还应用于其它原因引起的声门闭合不全的矫正，包括声带缺损、…     

电声门图参数与声嘶的心理听觉评价的相关关系研究

目的 研究电声门图参数与声嘶程度心理听觉评价之间的关系。方法 对134例受试者进行电声门图(EGG)检查,按心理听觉评估结果,根据GRBAS分级,将36例正常人及98例病理嗓音患者分成四组,对各组的电声门图参数及其与声嘶程度的关系进行统计学处理。结果 各组EGG参数均有显著性差异,标准化噪声能量(NNE)与接触率(CQ)是判别声嘶程度最有意义的两个参数,5个参数(jittter,shimmer,NNE,CQ,CQP)均与声嘶程度心理听觉评价有良好的相关关系,且频率微扰与粗糙声(R),NNE、CQ与气息声(B)相关性较好。结论 电声门图作为一种反映声带振动模式的方法,它和心理听觉评价声嘶的分级和程度有显著相关性,两者皆为临床应用提供诊断依据,但前者更为客观精确。     

声带外侧自体脂肪注射填充术治疗声门闭合不良

目的对声带外侧自体脂肪注射填充术方法选择、预后及其影响因素进行研究,探讨声带外侧自体脂肪注射在声门闭合不良性发声障碍治疗中的价值。方法病例选择:29例声门闭合不良、发声障碍患者,27例为单侧声带麻痹(麻痹时间均超过半年),2例为声带萎缩。手术选择:全麻支撑喉镜下,应用特制Brunning高压脂肪注射器进行自体脂肪声带外侧注射。患者手术前后均行嗓音声学、气流动力学及频闪喉镜检查,确定患者发音质量及疗效。结果术后随诊10～18个月,24例患者发声明显改善,2例发声好转,3例无效。注射1个月后脂肪部分吸收,声门闭合程度及发音逐渐改善。3～6个月声带振动、声门闭合正常,发声明显改善,音质稳定,主、客观声学评价及气流动力学参数改善明显(P<0.01)。结论单侧声带麻痹或声带萎缩引起的声门闭合不良,选择声带外侧声门旁间隙脂肪注射手术,使声带膜部内移,改善声门闭合,并保留声带振动特性,患者可获得良好的发音效果。     

Two‐Dimensional Analysis of Vocal Fold Vibration in Unilaterally Atrophied Larynges

Objective Considerable inconsistencies regarding the vibratory pattern of the vocal fold among patients with unilateral vocal fold paralysis (UVFP) have been reported. These differences are derived from differences in the position, stiffness, and atrophy of the paralyzed vocal fold and other factors among patients. The purpose of this study was to assess the effects of unilateral atrophy of the vocal fold on vocal fold vibration. Methods Seven excised canine larynges were studied. The unilateral recurrent laryngeal nerve was severed to cause vocal fold atrophy in four of the seven. The lateral and vertical displacements were monitored simultaneously with photoglottography and a laser Doppler vibrometer, respectively. Videostroboscopy of each larynx was also performed before and after the experiment to translate photoglottographic output into absolute lengths. Atrophy of the unilateral vocal fold was confirmed histologically. Results The lateral amplitude was significantly greater than the vertical amplitude in all larynges. The Lissajous trajectories in the normal larynges were shaped like a reverse crescent. Vibration in the unilaterally atrophied larynges was periodical and symmetrical in phase when the thyroid ala on the atrophied side was pressed medially. The lateral and vertical amplitudes on the atrophied side were significantly greater than those on the normal side. The Lissajous trajectories differed from those of the normal larynges. Conclusions In the absence of a prephonatory glottal gap, periodical vibration occurs in unilaterally atrophied larynges and the amplitude of vibrations of the atrophied vocal fold is greater in the lateral and vertical directions than that of the normal fold. This implies that phonosurgical procedures aiming at closure of the prephonatory glottal gap may have a beneficial effect on hoarseness in UVFP patients, although displacements of the vocal folds during vibration are not symmetrical.     

改良杓状软骨内收术治疗单侧声带麻痹

目的评估改良杓状软骨内收术治疗单侧声带麻痹的疗效。方法回顾性分析2001年2月～2007年12月22例行改良杓状软骨内收术的单侧声带麻痹患者的临床资料,对术前和术后3个月的误吸指数、主观听感知评估参数（GRBAS）、声学检测参数[基频（F0）、基频微扰（jitter）、振幅微扰（shimmer）、标准化噪声能量（NNE）]、最大声时（MPT）、平均气流率（MFR）进行统计学分析。结果22例患者术后误吸指数分值较术前明显下降,GRBAS评估各参数比术前明显下降,声学检测各参数（F0、jitter、shimmer、NNE）较术前明显降低,最大声时明显延长,平均气流率明显降低,差异均有统计学意义（均为P〈0.001）。结论改良杓状软骨内收术是一种治疗单侧声带麻痹有效的声带内移术,既可恢复良好的发声功能,又可缓解误吸。     

Videostroboscopic assessment of unilateral vocal fold paralysis after augmentation with autologous fascia

Vocal fold augmentation by injection laryngoplasty is a simple and fast procedure. The aim of this prospective study was to assess the glottal closure and the travelling mucosal wave by videostroboscopic images after autologous fascia augmentation in unilateral vocal fold paralysis (UVFP) with a special reference to objective analysis of voice. A total of 14 UVFP patients with poor voice and open glottal gap were assessed by videostroboscopy, blinded perceptual evaluation of running speech and acoustical analysis of sustained vowel. Data were collected before the procedure and at a supplementary evaluation 5–32 months (mean: 13 months) after injection of autologous fascia deep into the paralysed vocal fold. Mean age was 59 years; there were eight women and six men. Frame-by-frame video analysis revealed that before the operation 10 out of 12 had large glottal gaps without any contact between vocal folds on phonation. After the procedure seven gaps were completely closed, four partly, and two had no mucosal contact in stroboscopic examination. Maximum gap between vocal folds decreased from 7.21 units to 1.65 units (paired t-test P<0.001). Mucosal wave amplitude symmetry and phase synchrony were present in most subjects with partial closure and phase synchrony in every patient with a proper glottic closure. A panel of listeners rated voice to be significantly better (P<0.01) ) after the procedure, and the improvement in acoustical parameters was also statistically significant (P<0.01). There was a good correlation between objective voice analysis and videostroboscopy. Residual glottal gap was the major reason for less than optimal postoperative voice. No signs of hampered mucosal wave were noticed. Videostroboscopy and objective voice analysis suggest that augmentation by autologous fascia does not induce scar or fibrous tissue in the subepithelial space. Slight over-correction should be attempted initially in order to accomplish sufficient augmentation. This might enhance complete glottic closure and improve the outcome.     

电声门图测试对声带占位性病变的筛查价值

目的 探讨电声门图(electroglottography，EGG)测试在声带占位性病变中的筛查价值。方法 对134例声门型喉癌、167例声带良性病变(包括113例声带息肉、17例声带囊肿和37例声带白斑)及62名健康志愿者进行EGG测试，进行组间和组内比较，分析EGG测试的敏感性和特异性。结果 声带良性病变和喉癌组EGG波形和参数多数异常，与健康组之间有显著性差异，且良恶性病变组间亦有差异。但良性病变组内即息肉、囊肿和白斑之间，以及喉癌组内不同T分期之间EGG波形和参数差异多数无统计学意义。结论 电声门图测试在声带占位性病变的筛查中具有较高的敏感性，对区分良恶性病变亦有一定的特异性，但对病变类型和期别的划分无价值。     

钛夹植入I型甲状成形手术经验

目的探讨以钛夹为植入体行甲状成形手术治疗单侧声带麻痹引起的声门关闭不全的可行性。方法以钛夹为植入体为15例单侧声带麻痹患者进行I型甲状成形手术,从而内移声带,使声门能够闭合,手术前后进行喉镜、嗓音评估比较,明确病情改善情况。结果术后定期行内镜检查发现麻痹声带得到显著内移,张力提高,声门得到闭合,嗓音障碍指数量表（VHI）发现术后总评分,功能、生理、情感评分均得到改善;手术前后评分比较,差异具有统计学意义（P<0.05）,达到了患者改善病情的目的。结论钛夹植入物容易放置,对喉内组织刺激小,所至肿胀轻,是治疗因单侧声带麻痹而出现声门闭合不全的一项安全有效的方案之一。