脱细胞真皮基质补片在腭裂修复术改善腭裂语音中的应用

摘要

目的 观察脱细胞真皮基质补片在腭裂修复术对语音改善的应用疗效.方法 88例腭裂患者随机分为2组,其中对照组44例采用兰氏两瓣法加腭帆提肌重建术进行修复,试验组44例采用兰氏大术式及腭帆提肌重建基本术式基础上联合脱细胞真皮基质补片修补两侧松弛口裸露骨面.观察2组患者术后在提高患儿术后腭咽闭合优良率、语音清晰度主观评价优良率、吹水泡试验最长维持时间的效果.结果 试验组腭咽闭合率为79. 55% (35/44)明显高于对照组的45. 45% (20/44),差异有统计学意义(P＜0. 05). 2组术后患儿吹水泡试验的最长维持时间较术前均明显升高,且试验组吹水泡试验的最长维持时间明显高于对照组,差异均有统计学意义(P＜0. 05).试验组语音清晰度主观测评优良率明显高于对照组,差异有统计学意义(P＜0. 05).试验组患儿术后发a、i发音时前3个共振峰频率值明显高于对照组,差异有统计学意义(P＜0. 05).结论 脱细胞真皮基质补片应用于腭裂修复手术中,能改善腭裂患儿术后语音,是一种行之安全有效的方法,值得临床实践中进一步推广.%[Abstrsct] Objective To observe the effects of acellular dermal matrix patch on speech sound after palatorrhaphy. Methods A total of 88 patients with cleft palate were randomly divided into 2 groups,44 patients in control group were treated by two gram flap method combined with levator palatine velum reconstruction, however, the other 44 patients in experimental group,on the basis of control group, were treated by acellular dermal matrix patch covering the exposed bone surface and bilateral relaxation incision. After treatment the postoperative velopharyngeal closure rate,excellent rate of speech articulation by subjective assessment,the longest time of blowing bubble test were observed and compared between the two groups. Results The postoperative velopharyngeal closure rate in experimental group was 79. 55% (35/44),which was significantly higher than that [45. 45% (20/44)] in control group (P＜0. 05). The longest time of blowing bubble test was prolonged in both groups, as compared with that before treatment , moreover, the longest time of blowing bubble test in experimental group was significantly longer than that in control group (P＜0. 05). In addition the excellent rate of speech articulation by subjective assessment in experimental group was significantly higher than that in control group (P＜0. 05). The formant frequency value before a,I phonation in experimental group was significantly higher than that in control group ( P＜0. 05). Conclusion The acellular dermal matrix patch used in cleft palate repairing can improve postoperative phonation of patients,which is an effective and safe method,thus, it is worthy of further promotion in clinical practice.