New insights into the pathomechanism of postintubation arytenoid subluxation
New insights into the pathomechanism of postintubation arytenoid subluxation
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DOI：
10.1097/00000542-199909000-00016
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发表时间：
1999-09-01
期刊：
影响因子：
8.8
通讯作者：
Tillmann, BN
中科院分区：
文献类型：
--
作者：
Paulsen, FP;Rudert, HH;Tillmann, BN
工作背景：气管内潜伏期可导致环杓关节运动障碍，伴有声音嘶哑和声带不动。环杓半脱位的生物力学和pathomechanism尚未被证明data.Methods：本研究试图模拟创伤，已与杓状软骨半脱位在插管试验37个不固定的尸体从25至89岁的人喉。根据先前的杓状软骨半脱位概念进行喉插管或拔管，该概念假设杓状软骨尖端进入气管插管的管腔，或者在气管插管的套囊仅部分放气的情况下拔出气管插管期间杓状软骨发生偏转。此外，还尝试手动半脱位杓状软骨。随后解剖后，从每个喉的左，右环杓关节，实验诱导的形态学变化进行了分析，使用肉眼显微镜和组织学的方法。结果：在实验范围内，它被证明是不可能产生任何半脱位的环杓关节。组织学分析显示滑膜皱襞损伤、关节软骨的关节面压痕以及部分关节软骨下骨区域的骨折。根据形态学结果，可以得出结论，环杓关节的插管创伤本身不会引起半脱位，而是关节积血或关节体骨折的形成导致关节表面固定在异常位置。随后可能发生关节强直。
Background: Impaired movement of the cricoarytenoid joint with hoarseness and immobility of the vocal ligament can occur as a consequence of endotracheal incubation. The biomechanics and pathomechanism of cricoarytenoid subluxation have not been demonstrated to date.Methods: The present study attempts to simulate the trauma that has been associated with arytenoid cartilage subluxation in intubation trials on 37 unfixed larynges in cadavers from persons aged 25 to 89 years. Larynges were intubated or extubated according to former conceptions of arytenoid subluxation, which assume that the arytenoid tip enters the lumen of the tracheal tube, or that a deflection of the arytenoid occurs during withdrawal of the endotracheal tube with the cuff of the tube only partially deflated. Also, manual attempts were carried out to subluxate the arytenoid cartilage. Subsequently after dissecting the left and right cricoarytenoid joint from each larynx, the morphologic changes induced experimentally were analyzed using gross microscopic and histologic methods.Results: Within the scope of the experiment, it proved impossible to produce any subluxation of a cricoarytenoid joint. Histologic analysis revealed injuries of synovial folds, joint-surface impressions of the articular cartilage, and fractures in the area of the subchondral bone in some joints.Conclusions: Based on the morphologic results, it was concluded that intubation trauma of the cricoarytenoid joint does not cause subluxation per se, but rather that formation of a hemarthros or fractures of the joint bodies lead to fixation of the joint surfaces in an abnormal position. Subsequent ankylosis may occur.