颈前路人工椎间盘置换术与颈前路椎间减压融合术后吞咽困难并发症的比较分析

A comparison of anterior artificial disc insertion and anterior cervical discectomy and fusion in postoperative dysphagia

目的:评估颈前路人工椎间盘置换术(anterior artificial disc insertion,AADI)和颈前路椎间减压融合术(anterior cervical discectomy and fusion,ACDF)两种不同术式对术后早期吞咽功能的影响。方法:回顾性分析2010年1月-2011年4月收治的98例接受单节段或双节段神经根型/脊髓型颈椎病患者。按治疗方法分为两组,A组53例,采用AADI术式,B组45例,采用ACDF术式。对比两组患者术后48h、2个月及6个月时吞咽困难发生率、吞咽生活质量(Swallowing-Quality of Life,SWAL-QOL)评分及椎前软组织厚度的改变,比较两种术式吞咽困难并发症的发生情况。结果:A组患者手术时间(85.66±11.84min)明显低于B组(93.78±14.81min)(P<0.05)。在术后48h及术后2个月随访时,A组患者吞咽困难发生率(30.19%,3.77%)和椎前软组织厚度(10.99±1.66mm,10.17±1.87mm)明显低于B组患者(分别为51.11%,15.56%,11.92±1.59mm,11.45±1.59mm)(P<0.05)。术后48h和2个月时,A组患者SWAL-QOL评分(59.20±7.23,63.77±3.37)明显高于B组(53.91±8.99,62.07±4.51)(P<0.05)。术后6个月随访时,两组间各指标无统计学差异。结论:相对于ACDF,AADI手术时间较短,手术过程及置入物对食道的损伤和刺激较小,术后吞咽困难发生率和吞咽困难的严重程度较低。

Objectives： To evaluate the influence of anterior artificial disc insertion（AADI） and anterior cervi- cal discectomy and fusion（ACDF） on postoperative dysphagia. Methods： 98 patients undergoing one-level and two-level AADI and ACDF were retrospectively reviewed in this study. There were 53 patients in group A who underwent AADI and 45 patients in group B who underwent ACDF. The operation time and blood loss were recorded. The dysphagia rate, Swallowing-Quality of Life（SWAL-QOL） score and the thickness of prever- tebral soft tissue at each follow-up were compared. Results： The operation time was significantly lower in group A（85.66±11.84min） than that of group B（93.78±14.81min）（P〈0.05）. The dysphagia rate and thickness of prevertebral soft tissue thickness were significantly lower in group A at 48 hours and 2 months postoperative- ly（30.19%, 3.77%, 10.99±1.66mm, 10.17±1.87mm） than that of group B（51.11%, 15.56%, 11.92±1.59mm, 11.45±1.59mm）（P〈0.05）. The SWAL-QOL score of group A（59.20±7.23, 63.77±3.37） was significantly higher at 48 hours and 2 months postoperatively than that of group B（53.91±8.99, 62.07±4.51）（P〈0.05）. No significant difference between groups were observed at 6 month follow-up. Conclusions： AADI is associated with a less operation time, a less irritation to prevertebral soft tissue and a lower dysphagia rate at the first several months postoperatively.