颈椎前路手术后吞咽困难的原因分析

Related factors analysis of dysphagia following anterior cervical discectomy and fusion

目的:探讨颈椎前路手术后发生吞咽困难的相关因素。方法:随访2002年10月～2004年10月间颈椎前路手术患者490例,其中男306例,女184例;年龄12～76岁,平均47.2岁;诊断为颈椎病415例,颈椎骨折脱位43例,颈椎间盘突出症22例,颈椎椎体肿瘤8例,颈椎结核2例。观察患者手术后是否存在吞咽困难;对于存在吞咽困难的患者均静脉应用地塞米松及对症治疗。结果:共有96例(19.6%)患者出现不同程度吞咽困难,持续时间3周～24个月。男42例,女54例,年龄38～63岁,平均57.6岁。96例吞咽困难患者中,使用钛板内固定89例,使用颈椎椎间融合器7例;颈椎融合术未加内固定者及颈椎人工间盘置换者均未出现吞咽困难病例。女性、高龄及使用钛板内植物等因素与吞咽困难之间存在相关性。96例患者平均随访14.2个月,90例(93.7%)吞咽困难的症状消失或减轻,6例(6.3%)症状无改善。结论:吞咽困难是颈椎前路手术后常见的并发症;其发生可能与多种因素有关。临床医生应给予相应重视和采取相应措施以减少其发生。

Objective： To evaluate the related factors of dysphagia following anterior cervieal decompression and fusion.Method：490 cases undergoing anterior discectomy decompression and fusion from October 2002 to October 2004 were followed up,of these,there were 306 males and 184 females,with the mean age of 47.2 years （range, 12 to 76 years）.Of these 490 patients,415 had cervical spondylosis,43 had cervical fracture or dislocation,22 had cervical disc herniation,8 had cervical spine tumor,and 2 had cervical spine tuberculosis. 490 patients were reviewed retrospectively postoperatively about their swallow dysfunction（objective） and swallow comfortlessness （subjective）.All cases with dysphgia accepted dexamethasone used intravenously and correspondant therapy.Result：490 cases were followed up, and 96 （19.6%） of them had postoperative dysphagia which lasted for 3 weeks to 2 years.Of 96 patients with dysphagia,with the mean age of 57.6 yeas（range,38 to 63 years）.Of 96 patients with dysphagia,89 cases had titanium plates placement,7 cases had intervertebral cages placement.Those without plates or cages placement and those with artificial disc placement had no postoperative dysphagia.Female,elder and titanium plates planting was associated with postoperative dysphagia. After 14.2 months follow-up,90 cases（93.7%） with dysphagia cured or improved,while 6 cases had no improvement. Conclusion：Postoperative dysphagia is a common complication associated with anterior cervical discectomy and fusion,the causemay be multifactory.As a result,clinicians should pay more attention to this complication and make proper intervention.