Desuter Gauthier, Henrard Sylvie, Van Lith-Bijl Julie T, Amory Avigaëlle, Duprez Thierry, van Benthem Peter Paul, Sjögren Elisabeth
Otolaryngology Head and Neck Department, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.
Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium.
J Voice. 2017 Mar;31(2):245.e3-245.e8. doi: 10.1016/j.jvoice.2016.08.010. Epub 2016 Oct 18.
This study aimed to determine whether the shape of the thyroid cartilage and gender influence voice outcomes after a Montgomery thyroplasty implant system (MTIS).
A retrospective cohort study was performed on 20 consecutive patients who underwent MTIS. Voice outcome variables were the relative decrease in Voice Handicap Index (%) and the absolute increase in maximum phonation time (MPT) (in seconds). Material variables were the angle between the thyroid cartilage laminae (α-angle), the size of the prosthesis, and a combination of both (the α-ratio). Continuous variables were analyzed using medians and were compared between groups using the Mann-Whitney U test. Factors associated with the outcome variables were assessed by multivariable linear regression. A Pearson coefficient was calculated between material variables.
The absolute increase in MPT between the pre- and postoperative period was significantly different between men and women, with a median absolute increase of 11.0 seconds for men and of 1.3 seconds for women (P < 0.001). A strong inverse correlation between the α-ratio and the absolute increase in MPT is observed in all patients, with a Pearson correlation coefficient R = -0.769 (P < 0.001). No factors were significantly associated with the relative Voice Handicap Index decrease in univariable or multivariable analyses. A better Pearson coefficient between the α-angle and the prosthesis size was found for females (0.8 vs 0.71).
The MTIS is a good thyroplasty modality for male patients, but inadequate design of MTIS female implants leads to poor MPT outcomes. This represents a gender issue that needs to be further studied and eventually tackled.
本研究旨在确定甲状软骨形状和性别是否会影响蒙哥马利甲状腺成形术植入系统（MTIS）后的嗓音结果。
对连续20例行MTIS的患者进行回顾性队列研究。嗓音结果变量为嗓音障碍指数相对下降率（%）和最大发声时间（MPT，以秒为单位）的绝对增加值。材料变量为甲状软骨板之间的角度（α角）、假体大小以及两者的组合（α比率）。连续变量采用中位数进行分析，组间比较采用曼-惠特尼U检验。通过多变量线性回归评估与结果变量相关的因素。计算材料变量之间的皮尔逊系数。
术前和术后MPT的绝对增加值在男性和女性之间存在显著差异，男性的中位数绝对增加值为11.0秒，女性为1.3秒（P < 0.001）。在所有患者中，观察到α比率与MPT的绝对增加值之间存在强烈的负相关，皮尔逊相关系数R = -0.769（P < 0.001）。在单变量或多变量分析中，没有因素与嗓音障碍指数相对下降显著相关。女性的α角与假体大小之间的皮尔逊系数更好（0.8对0.71）。
MTIS对男性患者是一种良好的甲状腺成形术方式，但MTIS女性植入物设计不当导致MPT结果不佳。这代表了一个需要进一步研究并最终解决的性别问题。
