颈前路椎间盘切除植骨融合术后吞咽困难36例分析

Patients with dysphagia after anterior cervical discectomy and fusion: An analysis of 36 cases

目的 探讨颈前路椎间盘切除植骨融合（anterior cervical discectomy and fusion,ACDF）术后吞咽困难的原因、危险因素、治疗方法。方法 回顾性分析我科2013年1-12月收治的行ACDF患者355例。36例出现吞咽困难,其中男性12例,女性24例,平均年龄46.6（36~75）岁。结果 36例均随访6个月以上,分别于术后1~4 d、术后3个月、术后6个月记录Bazaz吞咽困难评分。术后1~4 d吞咽困难发生率10.1%,术后3个月、6个月分别为6.2%、2.3%。随访3个月时无重度吞咽困难患者。Logistic回归分析显示,多节段颈椎手术及高位颈椎手术是术后出现吞咽困难的危险因素。结论 多节段减压固定及高位颈椎手术是潜在的危险因素。术中注意保护颈部神经、采用甲泼尼龙治疗,可有效减少术后吞咽困难的发生。

Objective To discuss the cause, risk factors and treatment of dysphagia after anterior cervical discectomy and fusion （ACDF）. Methods Clinical data about 36 cases with dysphagia selected from 355 cases who accepted ACDF in our hospital from January 2013 to December 2013, including 12 males and 24 females with an average age of 46.6 years old （range from 36-75 years old）, were retrospectively analyzed. Results All the 36 patients with dysphagia, whose Bazaz＇s score were respectively recorded at postoperative 1-4 days, 3rd month and 6th month, were followed up at least 6 months. The incidence rate of dysphagia was 10.1% at postoperative 1-4 days, 6.2% at postoperative 3rd month, and 2.3% at postoperative 6th month. There were no cases with severe dysphagia at postoperative 3rd month. Logistic regression analysis showed that multiple segmental cervical spine surgery and high- level cervical spine surgery might be the risk factors of postoperative dysphagia. Conclusion Multiple segmental decompression and fusion and high cervical spine surgery are two potential risk factors. The occurrence of dysphagia after ACDF can be avoided by the protection of cervical nerves and the usage of methylprednisolone.