C2～7角变化对颈椎前路术后吞咽困难的影响

The role of C2-7 angle in the development of dysphagia after anterior cervical spine surgery

目的探讨C2～7角度变化对颈椎前路术后吞咽困难的影响。方法回顾性分析2007年6月至2010年5月，172例行颈前路减压钢板螺钉内固定术且至少随访1年的患者资料，男118例，女54例；年龄18-72岁，平均48．8岁。将所有患者按是否存在术后吞咽困难分成无症状组和吞咽困难组，研究手术前、后两组的C2～7角度变化（dC2～7角=术后C2～7角-术前C2～7角）对术后吞咽困难的影响，同时对两组的手术时间、出血量、翻修手术比例、手术包含节段数目、手术最高节段等相关影响术后吞咽困难的因素进行分析。结果吞咽困难组22例，男17例，女5例；年龄25-70岁，平均（47．7±5．4）岁；体重指数为（25．0±2．9）kg／m2。无症状组150例，男101例，女49例；年龄18-72岁，平均（49．2±4．8）岁；体重指数为（24．4±3．4）kg／m2。两组年龄、性别、体重指数比较差异均无统计学意义。吞咽困难组dC2～7角为-1°-20．5°，平均8．6°±4．0°；无症状组为-130°-28．5°，平均5．0°±4．3°；吞咽困难组与无症状组患者dC2～7角比较，差异有统计学意义。dC2～7角与术后吞咽困难行Spearman秩相关分析，结果显示两者存在显著相关性。将dC2～7≥5。时吞咽困难发病率（19．3％，17／88）与dC2～7〈5。时（6．0％，5／84）比较，差异存在统计学意义。将22例吞咽困难组患者的dC2～7角与其吞咽困难等级进行Spearman秩相关分析，结果显示两者无相关性。手术时间、出血量、翻修手术比例、手术最高节段、手术节段数等危险因素在吞咽困难组和无症状组之间无统计学差异。Logistic回归分析结果显示dC2～7角与术后吞咽困难显著相关，性别、年龄、体重指数、手术节段数、手术最高节段、翻修手术比例、手术时间、失血量均不影响术后吞咽困难症状的发生。结论C2～7角度变化对于颈椎前路术后吞咽困难的发生有重要影响，未发现手术时间、术中出血量、翻修手术比例、手术节段数、手术最高节段水平等因素与术后吞咽困难的关联。颈椎手术时注意术中监测C2～7角度变化或可有效减少术后吞咽困难的发生。

Objective To analyze the relationship between cervical lordosis and the development of dysphagia after anterior cervical spine surgery. Methods From June 2007 to May 2010, data of 172 successive patients who had undergone ACDF operation in our hospital were reviewed in this study. The presence and duration of postoperative dysphagia were recorded via face-to-face questioning or telephone interview at least one year after the procedure. Plain cervical radiographs before and after surgery were collected. The C2-7 angle was measured. The change of C2-7 angle was defined as dC2-7 angle=postoperative C2-7 - pre- operative C2-7 angle. The correlation between postoperative dysphagia and dC2-7 angle was studied. Results There were 22 pa- tients in dysphagia group, including 17 males and 5 females. Their age ranged from 25 to 70 years old, and average was 47.7±5.4. The average of BMI was 25.0±2.9 kg/m2. 150 patients were in non-dysphagia group, including 101 males and 49 females. Their age ranged from 18 to 72 years old, and average age was 49.2±4.8. The average of BMI was 24.4±3.4 kg/m2. There was no statisti- cal difference in gender, age, and BMI between two groups. The dC2-7 angle of dysphagia group ranged from -1°-20.5°, and aver- age was 8.6°±4.0°. The dC2-7 angle of non-dysphagia group ranged from -13°-28.5°, and average was 5.0°±4.3°. There was signifi- cant difference in dC2-7 angle between dysphagia and non-dysphagia group. Spearman Analysis revealed that there was strong cor- relativity between dC2-7 angle and postoperative dysphagia. When dC2-7 angle was greater than 5°, the chance of developing postop- erative dysphagia significantly increased （19.3% [17/88] vs 6.0% [5/84]）. What＇s more, Spearman Analysis also revealed that there was no correlativity between dC2-7 angle and degree of operative dysphagia. There was no significant difference in gender, age, and BMI between dysphagia and non-dysphagia group. There was no statistical difference in operative time, blood loss revision sur- gery, revision surgery ratio, most cephalic operative level and number of operative levels between dysphagia with non-dysphagia group. Logistic regression model showed that an increased likelihood of postoperative dysphagia persists with increasing dC2-7 an- gle, but had no relationship with operative time, blood loss, revision surgery, most cephalic operative level and number of operative levels. Conclusion dC2-7 angle may play an important role in the development of postoperative dysphagia. We found no statisti-cal difference in operative time, blood loss revision surgery, revision surgery ratio, most cephalic operative level and number of op- erative levels between dysphagia and non-dysphagia group. Intraoperative measurement of the dC2-7 angle is practical and essential for reducing the postoperative dysphagia.