Amedee R G, Mann W J
Department of Otolaryngology, University of Freiburg, West Germany.
Otolaryngol Head Neck Surg. 1989 Jun;100(6):542-5. doi: 10.1177/019459988910000603.
A modification of the Clerf arytenoidopexy treatment for bilateral vocal cord paralysis is described; it consists of an external approach with complete unilateral division of the posterior cricoarytenoid and interarytenoid muscles. The entire arytenoid is next mobilized and tilted laterally, then fixed into position along the posterior margin of the thyroid cartilage by two or three permanent retention sutures. Careful placement of these sutures renders the laryngeal mucosa maximally undisturbed and is largely responsible for the predictable results achieved with this technique. During the past 2 years, 18 patients received this static procedure, and 17 of 18 (94%) required a tracheotomy as part of the treatment because of a uniformly severe degree of glottic obstruction. All tracheotomy patients have been permanently decannulated (on an average) 14 days after surgery. The evaluation of each patient included pre- and post-operative measurements of airway resistance that correlated well with the width of the posterior commissure, and proved invaluable in successful decannulation efforts.
本文描述了一种改良的用于双侧声带麻痹的克莱夫杓状软骨固定术；该手术采用外部入路，完全单侧切断环杓后肌和杓间肌。接下来将整个杓状软骨游离并向外侧倾斜，然后通过两到三根永久性固定缝线沿着甲状软骨后缘固定到位。这些缝线的精心放置可使喉黏膜受到的干扰降至最低，这在很大程度上是该技术取得可预测效果的原因。在过去两年中，18例患者接受了这种静态手术，18例中有17例（94%）因声门梗阻程度均一严重，需要进行气管切开作为治疗的一部分。所有接受气管切开的患者术后平均14天已永久性拔管。对每位患者的评估包括术前和术后气道阻力测量，其与后联合宽度密切相关，在成功拔管过程中证明非常有价值。
