腭托治疗运动性构音障碍伴重度腭咽闭合功能不全的疗效评价

The effect evaluation of palatal lift prosthesis used in the patients with dysarthria and severe velopharyngeal insufficiency

摘要:

目的： 探讨腭托对运动性构音障碍患者疗效和鼻流量的影响。方法： 纳入2020年4月至2021年1月在滨州医学院附属医院康复医学科行语言训练的18例（15例男性和3例女性）运动性构音障碍伴重度腭咽闭合功能不全患者，年龄16~59岁，平均年龄38.0岁。腭托组行佩戴腭托及康复生理法训练（不包括克服鼻音化的训练），单纯训练组仅行康复生理法训练，疗程20 d。2组患者行腭咽部侧位X线片（摄静止及发/i/音像各1张）测量，行鼻流量检测仪测试鼻流量，测定最长发声时间、发音轮替运动速度及言语清晰度。结果： 运动性构音障碍伴重度腭咽闭合功能不全患者软腭动度角减小，相对腭咽闭合不全率增大。腭托组软腭动度角较治疗前明显增大，软腭与咽后壁的最短距离及相对腭咽闭合不全率较前明显减小，鼻流量明显减少，最长发声时间明显延长，发音轮替运动速度明显加快，言语清晰度明显改善，佩戴腭托并训练即治疗后上述指标改善更加明显。结论： 腭托是一种改善运动性构音障碍伴重度腭咽闭合功能不全患者鼻音化的有效手段，亦可改善患者的最长发声时间、发音轮替运动速度及言语清晰度。

Abstract:

Objective: To investigate the effect of palatal lift prosthesis (PLP) on the curative effect and nasal flow of patients with dysarthria. Methods: From April 2020 to January 2021, 18 patients (15 males and 3 females) with dysarthria and severe velopharyngeal insufficiency (VPI) who underwent language training in the Department of Rehabilitation Medicine, Binzhou Medical University Hospital were included in the study, aged from 16 to 59, with an average age of 38.0 years old. The PLP group received PLP and rehabil-itation training (excluding training to overcome nasalization) , and the pure training group only received rehabilitation training, with a treatment course of 20 days. The two groups of patients underwent velopharyngeal lateral X-rays (photostatic and phonation/i/audiovisual each) measurement, and nasal flow tester to test the nasal flow, to determine the longest vocalization time, the speed of vocal rotation and the speech clarity. Results: In patients with dysarthria and severe VPI, the soft palate movement angle decreased, and the relative VPI rate increased. In the PLP group, the angle of movement of the soft palate was significantly increased compared to before treatment. The shortest distance between the soft palate and the posterior pharyngeal wall and the relative VPI rate were significantly reduced compared with before, the nasal flow was significantly reduced, the longest vocalization time was significantly prolonged, and the pronunciation was alternated. Movement speed was significantly increased, speech clarity was significantly improved, and the above indicators improved more significantly after wearing PLP and undergoing the training. Conclusion: PLP is an effective method to improve nasalization in patients with dysarthria and severe VPI. It can also improve the patient's longest vocalization time, vocal rotation speed and speech clarity.