腭成形术对腭咽闭合及语音影响的临床研究
发布时间：2018-08-17 09:06
【摘要】：目的:腭成形术的目的是恢复腭裂患者腭部正常解剖形态，改善术后生理功能，形成良好的腭咽闭合(Velopharyngeal Competence，VPC)，为获得良好的语音创造条件。近年来随着手术年龄的提前，手术技术的提高，腭成形术后患者的语音较之以前有了明显的改善。为了进一步了解腭成形术后患者腭咽闭合的状态及语音改善的情况，本研究应用4种方法对腭成形术后患者的腭咽闭合及语音进行评价。 方法: 1临床病例资料 1.1病例来源 病例选自2005年1月-2013年7月在河北医科大学口腔医院口腔颌面外科行腭裂Ⅰ期手术的102例腭裂患者。其中，男性55例，女性47例；最小年龄3岁，最大年龄35岁，平均年龄10.2岁。术后评价时间最短为术后3个月，最长为术后96个月，，平均评价时间为术后25.1个月。 1.2病例分类 102例腭裂包括Ⅰ°腭裂（悬雍垂裂）4例，Ⅱ°腭裂（部分腭裂）69例， Ⅲ°腭裂（自悬雍垂至牙槽突全层裂开）29例。 1.3术式 102例腭裂患者中，53例行软腭逆向双“Z”形瓣移位术，49例行两瓣后推术。 2评价方法 2.1语音清晰度测试 腭裂患者分别于术前术后在专业录音室内按照语音清晰度测试表内容进行语音录音，3名审听者在专业录音室内听取其录音，得出各自审听结果（正确字数/所有字数×100%），取三者平均值得出语音清晰度测试结果。 2.2语音频谱分析 采用Vs-99语音分析系统的线性预测技术(LPC)，分别对腭裂术前、术后的/a/、/i/进行检测，记录发/a/、/i/音时前三个共振峰(F1、F2、F3)频率值，将结果与正常对照组相比较，进行统计学分析。 2.3头颅定位X线检查 采用头颅定位X线摄影技术对腭成形术后患者进行腭咽部侧位动态摄影，每位患者分别摄取静止位及发/i/音位影像，测得静止位及发/i/音位时咽腔深度，按评价标准评价腭成形术后患者的腭咽闭合情况。 2.4鼻咽纤维镜检查 采用鼻咽纤维镜技术对腭成形术后患者进行检查，记录其静止位及发/i/音位时的腭咽闭合情况，通过计算机软件计算其腭咽闭合不全改善率(rate of velopharyngeal incompetence,RVPI)，按评价标准评价腭成形术后患者的腭咽闭合情况。 结果: 1语音清晰度测试 1.1102例腭裂患者中，67.6%(69/102)的腭成形术后患者语音清晰度达70%以上。术前术后语音清晰度有显著性差(P0.05)。 1.2软腭逆向双“Z”形瓣移位术术后语音清晰度达70%以上的为77.4%(41/53)，两瓣后推术术后患者语音清晰度达70%以上的为57.1%(28/49)，两种术式有显著性差异(P0.05)。 2语音频谱分析 2.1发元音/a/时的频谱分析 在发元音/a/时腭裂术前与正常人相比较，前三个共振峰(F1、F2、F3)的频率值无显著性差异(P0.05)。 在发元音/a/时腭裂术后与正常人相比较，前三个共振峰(F1、F2、F3)的频率值无显著性差异(P0.05)。 在发元音/a/时腭裂术前与腭裂术后相比较，前三个共振峰(F1、F2、F3)的频率值无显著性差异(P0.05)。 2.2发元音/i/时的频谱分析 在发元音/i/时腭裂术前、腭裂术后与正常人相比较，第一共振峰(F1)的频率值均无显著性差异(P0.05)。另外，腭裂术前与腭裂术后相比较也无显著性差异(P0.05)。 在发元音/i/时，腭裂术前、术后的第二共振峰(F2)均低于正常人(P0.05)。另外腭裂术后高于腭裂术前(P0.05)。 在发元音/i/时，腭裂术前、术后的第三共振峰(F3)均低于正常人(P0.05)。另外，腭裂术后与腭裂术前相比无显著性差异(P0.05)。 3头颅定位X线检查结果 3.179.2%(19/24)的腭成形术后患者腭咽闭合良好。 3.2软腭逆向双“Z”形瓣移位术术后腭咽闭合良好率为92.9%(13/14)，两瓣后推术术后腭咽闭合良好率为60%(6/10)。 4鼻咽纤维镜检查结果 4.174.1%(20/27)的腭成形术后患者腭咽闭合良好。 4.2软腭逆向双“Z”形瓣移位术术后腭咽闭合良好率为86.7%(13/15)，两瓣后推术术后腭咽闭合良好率占58.3%(7/12)。 结论： 1腭成形术后67.6%的患者语音得到了明显改善，其中，软腭逆向双“Z”形瓣移位术术后语音改善明显好于两瓣后推术。 2腭成形术后79.2%的患者腭咽闭合良好。术后的腭咽闭合良好率高于语音清晰度改善，语音训练有望进一步提高腭成形术后患者的语音清晰度。 3主观语音清晰度测试可反映腭成形术后患者的语音改善情况，但不能客观评价其腭咽闭合状态；客观检查可反映腭成形术后患者的腭咽闭合状态，却不能完全代表其语音改善情况。故在临床上应将主观评价与客观检查相结合才可准确评价腭成形术后患者的腭咽闭合状态及语音改善情况。
[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.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R782.22
本文编号：2187138
[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.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R782.22
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