缝合椎前筋膜预防颈前路术后吞咽困难的临床研究

Clinical application of the reconstruction of prevertebral fascia in cervical vertebrae anterior approach

目的:探讨缝合椎前筋膜对颈椎前路内固定术后吞咽困难的预防作用。方法:将176例行颈前路手术、钛板内固定患者于手术前一天掷钱币方式随机分为2组。A组89例(缝合椎前筋膜组):术中颈前路钢板固定后缝合椎前筋膜,覆盖钢板,使食管不直接与钢板相贴。B组87例(不缝合椎前筋膜组):术中固定后不缝合椎前筋膜,食管与钢板直接相贴。分别于术后3周及3、12个月对患者进行随访,以吞咽困难患者数及吞咽困难发生率作为观测指标。结果:A组术后3周及3、12个月吞咽困难发生率分别为25.8%、9.0%、5.6%;B组为25.3%、20.6%、14.9%。经统计学处理,3、12个月时吞咽困难发生率A组低于B组,差异有统计学意义(3个月时P=0.030,12个月时P=0.049,均<0.05)。结论:缝合椎前筋膜能有效地预防颈椎前路内固定术后吞咽困难的发生。

Objective：To evaluate the preventive effect of the reconstruction of prevertebral fascia on the complication of cervical vertebrae anterior approach. Methods：One hundred and seventy-six patients with cervical vertebrae anterior approach were divided into two groups by throwing coins,coins for the positive,patients entered the group A,coins for the negative,patients entered the group B. Eighty-seven cases of group B were treated with cervical vertebrae anterior decompression,bone grafting and internal fixation with plate and screws. In other 89 cases of group A,prevertebral fascia were covered on the surface of the plate and screws as experiment group. The patients were followed up after three weeks,three months and 12 months. The incidence of the dysphagia was as observation indicator and was statistically analyzed. Results：The followed-up period was 3 weeks,3 months and 12 months after operation. The incidence of the dysphagia of group A was respectively 25.8%,9.0%, 5.6%;the incidence of the dysphagia of group B was respectively 25.3%,20.6%,14.9%. The dysphagia in the experiment group was lower than that in contrast group,3 months and 12 months after operation（3 months P=0.030,12 months P=0.049〈0.05）. Conclusion：The reconstruction of prevertebral fascia is an effective method to avoid the dysphagia of cervical vertebrae anterior approach.