Wang R C
Division of Otolaryngology-Head and Neck Surgery, University of Nevada School of Medicine, Las Vegas 89102, USA.
Laryngoscope. 1998 Apr;108(4 Pt 2 Suppl 86):1-17. doi: 10.1097/00005537-199804001-00001.
The normal motion of the cricoarytenoid joint was characterized and analyzed in this study using seven fresh cadaver larynges mounted rigidly in an external fixator apparatus after radiopaque markers were attached to laryngeal landmarks. Fluoroscopic imaging and recording was performed of top, front, and side views while the arytenoid cartilages of each larynx were manipulated through the full range of motion from adduction to abduction. Computer video capture was performed of the recordings and editing of still frames accomplished to generate three-dimensional plots of cricoarytenoid joint motion, which are shown in the manuscript. Selective and varying sequential disconnection of muscular and ligamentous structures to the arytenoid cartilage was achieved to determine their contributions to cricoarytenoid joint motion limitations and stability. The vocalis ligament, cricoarytenoid ligament, and conus elasticus are most important in controlling abduction, whereas the posterior cricoarytenoid muscle and conus elasticus are crucial in limiting adduction. The vocalis ligament prevents posterior displacement of the vocal process, while the cricoarytenoid ligament and a newly described ligament, the posterior capsular ligament, restricts anterior vocal process migration. Another ligament, the anterior capsular ligament, is described, which limits backward arytenoid cartilage tilting and lateral movement of the arytenoid cartilage on the cricoid cartilage facet. Section of the vocalis ligament with underlying conus elasticus produced reducible lateral arytenoid cartilage subluxation. Confirmation of cricoarytenoid joint facet relationships in full adduction and abduction was accomplished by fixation of the cricoarytenoid joints of one larynx in the two positions with adhesive, and subsequent exposure of the joint surfaces. Review of literature detailing human laryngeal embryological development shows that the glottis and arytenoid cartilages are formed in adduction, which explains how cricoarytenoid joint ligaments collaborate to achieve accurate vocal process approximation in adduction despite side-to-side asymmetries of the cricoarytenoid joint structures in the same larynges.
本研究对环状杓状软骨关节的正常运动进行了表征和分析。研究使用了七个新鲜尸体喉部，在向喉部标志点附着不透射线标记后，将其牢固安装在外部固定器装置中。在每个喉部的杓状软骨从内收运动到外展的整个运动范围内进行操作时，对顶部、正面和侧面视图进行了荧光透视成像和记录。对记录进行计算机视频捕捉，并完成静止帧编辑，以生成环状杓状软骨关节运动的三维图，这些图在论文中展示。通过选择性地、不同顺序地切断连接到杓状软骨的肌肉和韧带结构，以确定它们对环状杓状软骨关节运动限制和稳定性的贡献。声带韧带、环杓韧带和弹性圆锥在控制外展方面最为重要，而后环杓肌和弹性圆锥在限制内收方面至关重要。声带韧带可防止声带突向后移位，而环杓韧带和一种新描述的韧带——后囊韧带，可限制声带突向前迁移。还描述了另一种韧带——前囊韧带，它可限制杓状软骨向后倾斜以及杓状软骨在环状软骨小关节面上的侧向运动。切断声带韧带及其下方的弹性圆锥会导致可复位的杓状软骨外侧半脱位。通过用粘合剂将一个喉部的环状杓状软骨关节固定在两个位置，随后暴露关节面，证实了环状杓状软骨关节小关节面在完全内收和外展时的关系。对详细描述人类喉部胚胎发育的文献回顾表明，声门和杓状软骨是在内收状态下形成的，这解释了尽管同一喉部的环状杓状软骨关节结构存在左右不对称，但环状杓状软骨关节韧带如何协同作用以在内收时实现声带突的精确接近。
