颈长肌和前纵韧带重建对颈前路术后吞咽功能影响的临床研究

Clinical study on the effect of musculus longus colli and anterior longitudinal ligament reconstruction of swallowing function after anterior cervical fusion

目的观察颈前路融合术中重建颈长肌和前纵韧带对患者术后早期吞咽功能的影响,并探讨影响吞咽功能的相关因素。方法选择2012-10-2014-10我科收治的单节段或双节段病变的颈椎病患者316例。所有患者均行前路减压、植骨融合钢板内固定术,其中术后能够得到完整随访的患者共有241例。根据术中对颈长肌及前纵韧带处理方式不同将241例颈椎病患者分为A组(即缝合组,129例)、B组(即不缝合组,112例);然后再依据手术责任间隙分别将缝合组分为单节段缝合组(A1,72例)和连续双节段缝合组(A2,57例),未缝合组分为单节段(B1,62例)及连续双节段(B2,50例)组。通过对比分析各组患者在术后第2天、术后1周、1个月、3个月及6个月随访时的吞咽困难发生率、吞咽生活质量(SWAL-QOL)评分及椎前软组织平均厚度的变化情况。结果术后2天、术后1周、1个月随访时A1、A2两组患者吞咽困难发生率均明显低于B1、B2两组(P<0.05);A1、B1两组患者吞咽困难发生率与A2、B2两组相比较亦有明显差异统计学意义(P<0.05);A1、A2两组患者SWAL-QOL评分均明显高于B1、B2两组(P<0.05);A1、B1两组患者SWAL-QOL评分与A2、B2两组比较亦有明显差异统计学意义(P<0.05)。术后3、6个月随访时患者吞咽困难发生率及SWAL-QOL评分在各组内、组间比较均无统计学差异(P>0.05),且各组患者椎前软组织平均厚度在手术前后各次随访时比较亦无统计学差异(P>0.05)。结论颈前路减压、植骨融合内固定术中重建颈长肌和前纵韧带能够有效的减少术后早期吞咽困难发生率,且手术节段累及越多,术后吞咽困难发生率越高。

Objective To observe the effects of musculus longus colli and anterior longitudinal ligament of early swallowing function in patients after reconstruction of the anterior cervical fusion, and to explore the influencing factors of swallowing function. Methods From october2012 and october 2014,316 case of patients who suffer from single segment or double segment cervical spondylosis and receive anterior cervical fusion were retrospectively analyzed. And 241 patients who were able to get a complete follow-up were divided into single segmental suture（ A1）,double segmental suture group（ A2）,single segmental unstitched（ B1） and double segmental unstitched group（ B2）. The changes of incidence of dysphagia,Swallowing the quality of life（ SWAL-QOL） score and the average thickness of prevertebral soft tissue in groups were com-pared in 2days,1weeks,1months,3months and 6months follow-up. Results The dysphagia rate was significantly lower in A1、A2 two groups at 2 days、1weeks and 1 months postoperatively than that of groups B1、B2（ P〈0.05）. And the incidence rate of dysphagia in A1、B1 two groups was also significantly lower than that of A2、B2 two groups at 2 days、1weeks and 1 months postoperatively（ P〈0.05）. The SWAL-QOL score of A1、A2 two groups was significantly higher than that of B1、B2 two groups at 2 days 、1weeks and 1 months postoperatively（ P〈0.05）. And the SWAL-QOL score of A1、B1 two groups at 2 days、1weeks and 1 months postoperatively was also significantly higher than that of A2、B2 two groups（ P〈0.05）. There were no significant difference between groups with the incidence of dysphagia and SWAL-QOL score in each group at 3 months and 6 months follow-up（ P〉0.05）. And each group of patients with prevertebral soft tissue thickness in operation before and after was not statistical difference（ P〉0.05）. Conclusion The reconstruction of musculus longus colli and anterior longitudinal ligament in anterior cervical fusion and internal fixation can effectively reduce the incidence of postoperative early dysphagia,and operation section involving more, the higher incidence of dysphagia.