【摘要】：目的:腭成形術(shù)的目的是恢復(fù)腭裂患者腭部正常解剖形態(tài)，改善術(shù)后生理功能，形成良好的腭咽閉合(Velopharyngeal Competence，VPC)，為獲得良好的語(yǔ)音創(chuàng)造條件。近年來(lái)隨著手術(shù)年齡的提前，手術(shù)技術(shù)的提高，腭成形術(shù)后患者的語(yǔ)音較之以前有了明顯的改善。為了進(jìn)一步了解腭成形術(shù)后患者腭咽閉合的狀態(tài)及語(yǔ)音改善的情況，本研究應(yīng)用4種方法對(duì)腭成形術(shù)后患者的腭咽閉合及語(yǔ)音進(jìn)行評(píng)價(jià)。 方法: 1臨床病例資料 1.1病例來(lái)源 病例選自2005年1月-2013年7月在河北醫(yī)科大學(xué)口腔醫(yī)院口腔頜面外科行腭裂Ⅰ期手術(shù)的102例腭裂患者。其中，男性55例，女性47例；最小年齡3歲，最大年齡35歲，平均年齡10.2歲。術(shù)后評(píng)價(jià)時(shí)間最短為術(shù)后3個(gè)月，最長(zhǎng)為術(shù)后96個(gè)月，，平均評(píng)價(jià)時(shí)間為術(shù)后25.1個(gè)月。 1.2病例分類(lèi) 102例腭裂包括Ⅰ°腭裂（懸雍垂裂）4例，Ⅱ°腭裂（部分腭裂）69例， Ⅲ°腭裂（自懸雍垂至牙槽突全層裂開(kāi)）29例。 1.3術(shù)式 102例腭裂患者中，53例行軟腭逆向雙“Z”形瓣移位術(shù)，49例行兩瓣后推術(shù)。 2評(píng)價(jià)方法 2.1語(yǔ)音清晰度測(cè)試 腭裂患者分別于術(shù)前術(shù)后在專(zhuān)業(yè)錄音室內(nèi)按照語(yǔ)音清晰度測(cè)試表內(nèi)容進(jìn)行語(yǔ)音錄音，3名審聽(tīng)者在專(zhuān)業(yè)錄音室內(nèi)聽(tīng)取其錄音，得出各自審聽(tīng)結(jié)果（正確字?jǐn)?shù)/所有字?jǐn)?shù)×100%），取三者平均值得出語(yǔ)音清晰度測(cè)試結(jié)果。 2.2語(yǔ)音頻譜分析 采用Vs-99語(yǔ)音分析系統(tǒng)的線(xiàn)性預(yù)測(cè)技術(shù)(LPC)，分別對(duì)腭裂術(shù)前、術(shù)后的/a/、/i/進(jìn)行檢測(cè)，記錄發(fā)/a/、/i/音時(shí)前三個(gè)共振峰(F1、F2、F3)頻率值，將結(jié)果與正常對(duì)照組相比較，進(jìn)行統(tǒng)計(jì)學(xué)分析。 2.3頭顱定位X線(xiàn)檢查 采用頭顱定位X線(xiàn)攝影技術(shù)對(duì)腭成形術(shù)后患者進(jìn)行腭咽部側(cè)位動(dòng)態(tài)攝影，每位患者分別攝取靜止位及發(fā)/i/音位影像，測(cè)得靜止位及發(fā)/i/音位時(shí)咽腔深度，按評(píng)價(jià)標(biāo)準(zhǔn)評(píng)價(jià)腭成形術(shù)后患者的腭咽閉合情況。 2.4鼻咽纖維鏡檢查 采用鼻咽纖維鏡技術(shù)對(duì)腭成形術(shù)后患者進(jìn)行檢查，記錄其靜止位及發(fā)/i/音位時(shí)的腭咽閉合情況，通過(guò)計(jì)算機(jī)軟件計(jì)算其腭咽閉合不全改善率(rate of velopharyngeal incompetence,RVPI)，按評(píng)價(jià)標(biāo)準(zhǔn)評(píng)價(jià)腭成形術(shù)后患者的腭咽閉合情況。 結(jié)果: 1語(yǔ)音清晰度測(cè)試 1.1102例腭裂患者中，67.6%(69/102)的腭成形術(shù)后患者語(yǔ)音清晰度達(dá)70%以上。術(shù)前術(shù)后語(yǔ)音清晰度有顯著性差(P0.05)。 1.2軟腭逆向雙“Z”形瓣移位術(shù)術(shù)后語(yǔ)音清晰度達(dá)70%以上的為77.4%(41/53)，兩瓣后推術(shù)術(shù)后患者語(yǔ)音清晰度達(dá)70%以上的為57.1%(28/49)，兩種術(shù)式有顯著性差異(P0.05)。 2語(yǔ)音頻譜分析 2.1發(fā)元音/a/時(shí)的頻譜分析 在發(fā)元音/a/時(shí)腭裂術(shù)前與正常人相比較，前三個(gè)共振峰(F1、F2、F3)的頻率值無(wú)顯著性差異(P0.05)。 在發(fā)元音/a/時(shí)腭裂術(shù)后與正常人相比較，前三個(gè)共振峰(F1、F2、F3)的頻率值無(wú)顯著性差異(P0.05)。 在發(fā)元音/a/時(shí)腭裂術(shù)前與腭裂術(shù)后相比較，前三個(gè)共振峰(F1、F2、F3)的頻率值無(wú)顯著性差異(P0.05)。 2.2發(fā)元音/i/時(shí)的頻譜分析 在發(fā)元音/i/時(shí)腭裂術(shù)前、腭裂術(shù)后與正常人相比較，第一共振峰(F1)的頻率值均無(wú)顯著性差異(P0.05)。另外，腭裂術(shù)前與腭裂術(shù)后相比較也無(wú)顯著性差異(P0.05)。 在發(fā)元音/i/時(shí)，腭裂術(shù)前、術(shù)后的第二共振峰(F2)均低于正常人(P0.05)。另外腭裂術(shù)后高于腭裂術(shù)前(P0.05)。 在發(fā)元音/i/時(shí)，腭裂術(shù)前、術(shù)后的第三共振峰(F3)均低于正常人(P0.05)。另外，腭裂術(shù)后與腭裂術(shù)前相比無(wú)顯著性差異(P0.05)。 3頭顱定位X線(xiàn)檢查結(jié)果 3.179.2%(19/24)的腭成形術(shù)后患者腭咽閉合良好。 3.2軟腭逆向雙“Z”形瓣移位術(shù)術(shù)后腭咽閉合良好率為92.9%(13/14)，兩瓣后推術(shù)術(shù)后腭咽閉合良好率為60%(6/10)。 4鼻咽纖維鏡檢查結(jié)果 4.174.1%(20/27)的腭成形術(shù)后患者腭咽閉合良好。 4.2軟腭逆向雙“Z”形瓣移位術(shù)術(shù)后腭咽閉合良好率為86.7%(13/15)，兩瓣后推術(shù)術(shù)后腭咽閉合良好率占58.3%(7/12)。 結(jié)論： 1腭成形術(shù)后67.6%的患者語(yǔ)音得到了明顯改善，其中，軟腭逆向雙“Z”形瓣移位術(shù)術(shù)后語(yǔ)音改善明顯好于兩瓣后推術(shù)。 2腭成形術(shù)后79.2%的患者腭咽閉合良好。術(shù)后的腭咽閉合良好率高于語(yǔ)音清晰度改善，語(yǔ)音訓(xùn)練有望進(jìn)一步提高腭成形術(shù)后患者的語(yǔ)音清晰度。 3主觀(guān)語(yǔ)音清晰度測(cè)試可反映腭成形術(shù)后患者的語(yǔ)音改善情況，但不能客觀(guān)評(píng)價(jià)其腭咽閉合狀態(tài)；客觀(guān)檢查可反映腭成形術(shù)后患者的腭咽閉合狀態(tài)，卻不能完全代表其語(yǔ)音改善情況。故在臨床上應(yīng)將主觀(guān)評(píng)價(jià)與客觀(guān)檢查相結(jié)合才可準(zhǔn)確評(píng)價(jià)腭成形術(shù)后患者的腭咽閉合狀態(tài)及語(yǔ)音改善情況。
[Abstract]:Objective: The purpose of palatoplasty is to restore the normal anatomy of the palate, improve the postoperative physiological function, and form a good velopharyngeal Competence (VPC), so as to create conditions for good speech. In order to further understand the state of velopharyngeal closure and the improvement of speech in patients after palatoplasty, four methods were used to evaluate the velopharyngeal closure and speech in patients after palatoplasty.
Method:
1 clinical data
1.1 case source
From January 2005 to July 2013, 102 patients with cleft palate underwent primary palatofacial surgery in the Department of Oral and Maxillofacial Surgery of the Stomatological Hospital of Hebei Medical University, including 55 males and 47 females. The youngest age was 3 years, the oldest age was 35 years, and the average age was 10.2 years. The interval was 25.1 months after operation.
1.2 case classification
102 cases of cleft palate included 4 cases of_degree cleft palate (uvula cleft), 69 cases of_degree cleft palate (partial cleft palate), and 29 cases of_degree cleft palate (from uvula to alveolar process).
1.3 operation
In 102 patients with cleft palate, 53 cases underwent reverse double "Z" flap transposition of soft palate, and 49 cases underwent two flap backstepping.
2 evaluation method
2.1 speech intelligibility test
The cleft palate patients were recorded in the professional recording room according to the speech intelligibility test table before and after the operation. Three auditors listened to the recording in the professional recording room and got their respective auditing results (correct word/all words *100%). The average of the three auditors was taken to get the results of the speech intelligibility test.
2.2 speech spectrum analysis
The linear prediction technique (LPC) of Vs-99 speech analysis system was used to detect the first three formants (F1, F2, F3) before and after cleft palate surgery.
2.3 cephalometric radiographic examination
Head-positioned X-ray photography was used to take lateral dynamic photography of the palatopharynx of the patients after palatoplasty. The pharyngeal cavity depth was measured at rest and at / I / phoneme. The velopharyngeal closure of the patients after palatoplasty was evaluated according to the evaluation criteria.
2.4 nasopharyngeal fiberoptic examination
The velopharyngeal incompetence (RVPI) was calculated by computer software. The velopharyngeal closure was evaluated according to the evaluation criteria.
Result:
1 speech intelligibility test
1.1102 cleft palate patients, 67.6% (69/102) of the patients after palatoplasty speech intelligibility of more than 70%. Preoperative and postoperative speech intelligibility was significantly poor (P 0.05).
1.2 The speech intelligibility of soft palate patients after reverse double "Z" flap transposition was 77.4% (41/53) and 57.1% (28/49) respectively. There was significant difference between the two methods (P 0.05).
2 speech spectrum analysis
Spectral analysis of 2.1 vowel /a/
There was no significant difference in the frequencies of the first three formants (F1, F2, F3) between the patients with cleft palate before and after voweling/a/(P 0.05).
There was no significant difference in the frequencies of the first three formants (F1, F2, F3) between normal and cleft palate patients after vowel/a/operation (P 0.05).
There was no significant difference in the frequencies of the first three formants (F1, F2, F3) before and after cleft palate surgery at vowel/a/(P 0.05).
Spectral analysis of 2.2 vowel /i/
There was no significant difference in the frequency of the first formant (F1) between the cleft palate and the normal palate before voweling/i/h (P 0.05). There was no significant difference in the frequency of the first formant (P 0.05).
At vowel/i/I, the second formant (F2) of cleft palate was lower than that of normal palate (P 0.05). The second formant (F2) of cleft palate was higher than that of cleft palate (P 0.05).
At vowel / I / time, the F3 of cleft palate was lower than that of normal palate (P 0.05). In addition, there was no significant difference between cleft palate and preoperative palate (P 0.05).
3 cephalometric radiographic findings
Velopharyngeal closure was good after 3.179.2% (19/24) palatoplasty.
3.2 The good rate of velopharyngeal closure was 92.9% (13/14) and 60% (6/10) after reverse double "Z" flap transposition of soft palate.
4 nasopharyngeal fiberoptic examination results
Velopharyngeal closure was good after 4.174.1% (20/27) palatoplasty.
4.2 The good rate of velopharyngeal closure was 86.7% (13/15) and 58.3% (7/12) respectively after reverse double "Z" flap transposition of soft palate.
Conclusion:
In 67.6% of the patients after palatoplasty, the speech improvement of soft palate retrograde double "Z" flap transposition was better than that of two-flap retrograde palatoplasty.
The good rate of velopharyngeal closure after palatoplasty was higher than that of speech intelligibility. Speech training is expected to further improve the speech intelligibility of patients after palatoplasty.
3. Subjective speech intelligibility test can reflect the speech improvement of patients after palatoplasty, but it can not objectively evaluate the velopharyngeal closure; objective examination can reflect the velopharyngeal closure of patients after palatoplasty, but can not completely represent the improvement of their speech. It is necessary to evaluate velopharyngeal closure and speech improvement after palatoplasty.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R782.22

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 馮蘭云;王淑鳳;王知豐;;腭裂兒童早期術(shù)后語(yǔ)音治療與分析[J];中國(guó)康復(fù)理論與實(shí)踐;2012年10期

2 曹春雷;萬(wàn)延俊;張紅闖;朱效萍;;腭帆提肌重建聯(lián)合咽后壁瓣術(shù)在先天性腭裂中的臨床應(yīng)用[J];口腔醫(yī)學(xué);2012年06期

3 蘇偉;向述天;許章典;;腭裂修補(bǔ)術(shù)后腭咽閉合功能不全的X線(xiàn)診斷[J];中國(guó)醫(yī)學(xué)工程;2011年09期

4 楊麗;邵敏;佘小明;;八種腭成形術(shù)式對(duì)腭裂術(shù)后腭咽閉合功能的影響[J];口腔頜面外科雜志;2011年04期

5 安永謙;秦瑞峰;周麗華;張慧燕;聶浩劫;;不同術(shù)式對(duì)大齡腭裂患者的語(yǔ)音恢復(fù)影響的比較研究[J];中國(guó)傷殘醫(yī)學(xué);2010年04期

6 申鐵兵;孟秀英;;腭裂患兒術(shù)前術(shù)后腭咽閉合功能對(duì)比研究[J];現(xiàn)代中西醫(yī)結(jié)合雜志;2010年03期

7 黃健;欽傳奇;汪麗英;唐中;;應(yīng)用鼻咽纖維鏡評(píng)價(jià)改良Furlow's治療腭咽閉合不全的臨床效果[J];中國(guó)內(nèi)鏡雜志;2009年07期

8 陳仁吉;孫勇剛;張震康;楊增杰;;鼻咽纖維鏡生物反饋治療在腭裂術(shù)后語(yǔ)音治療中的應(yīng)用[J];北京口腔醫(yī)學(xué);2008年02期

9 施星輝;陳寧;邢樹(shù)忠;袁冶;姚衛(wèi)萍;;腭裂患者手術(shù)前后語(yǔ)音頻譜特點(diǎn)的研究[J];口腔醫(yī)學(xué);2008年02期

10 王予江;陳愛(ài)國(guó);梁凱;彭沖;童永青;;改良腭黏膜瓣整復(fù)軟腭裂的臨床觀(guān)察[J];口腔頜面外科雜志;2007年03期

本文編號(hào)：2187138