颈椎前路术后吞咽困难的相关原因分析

Cause analysis of dysphagia after anterior cervical spine surgery

目的 ：探讨颈椎前路术后发生吞咽困难的相关原因。方法 ：对2011年7月至2013年10月进行颈前路手术的328例患者进行回顾性分析,其中男157例,女171例;年龄28-81岁。手术方式包括颈椎体次全切钛网植骨融合内固定术、颈前路椎间盘摘除植骨融合内固定术、颈椎体次全切椎间盘摘除植骨融合内固定术、颈椎间盘置换。术后1个月根据Bazaz食道功能标准对患者进行评价,将所有患者分成吞咽困难组和吞咽正常组,比较两组年龄、性别、手术节段数、颈前路钛板使用率。结果：术后1个月共有63例患者出现吞咽困难,男19例,女44例,男女性别之间吞咽困难发生率差异有统计学意义（P=9.1×10-28〈0.05）;吞咽困难组：年龄38-81岁,平均年龄65.0岁;吞咽正常组：年龄28-73岁,平均年龄53.6岁;发生吞咽困难组与吞咽正常组之间年龄差异有统计学意义（P=1.4×10-8〈0.05）;63例吞咽困难患者均使用钛板内固定,而21例吞咽正常患者均为人工颈椎间盘置换（未使用颈前路钛板固定）,应用颈前路钛板固定与人工颈椎间盘置换术后的吞咽困难差异有统计学意义（P=0.018〈0.05）;手术单节段3例,双节段24例,3节段及3个以上节段36例,3节段及3个以上节段钛板内固定组与单、双节段钛板内固定组吞咽困难发生率之间差异有统计学意义（P=3.6×10-33〈0.05）。结论 ：颈前路术后吞咽困难的原因较多,其中应包括女性、高龄、钛板内固定的应用以及多节段手术等因素,临床医生在进行颈前路手术时应引起高度重视。

Objective：To investigate the correlation causes of dysphagia following the anterior cervical surgery.Methods：From July 2011 to October 2013,328 patients underwent anterior cervical surgery were retrospective reviewed,including 157 males and 171 females,aging from 28 to 81 years old.The methods of surgery included cervical body compectomy and titanium mesh bone fusion and internal fixation,anterior cervical intervertebral discectomy bone fusion and internal fixation,cervical body compectomy discectomy bone fusion and internal fixation,and artificial intervertebrae disc replacement.Postoperative 1month according to Bazaz esophagus function standard patients were evaluated at month after operation and divided into dysphagia group and normal group.The age,gender,the rate of the usage of anterior cervical plate and the segmental numbers of the operation were compared between the two groups.Results：All the cases were followed up,and 63（19.2%） of them had postoperative dysphagia,containing 19 males and 44 females,there was significant difference in the different gender（P=9.1×10-（-28）0.05）.The age of patients with postoperative dysphagia was from 38 to 81 years old with an average of 65 years old;the other patients＇ age was ranged from 28 to 73 years with an average of 53.6 years old,there was significant difference in age between dysphagia group and normal group（P=1.4×10-（-8）0.05）.All of 63 patients with postoperative dysphagia had been operated with anterior cervical plate,but all of 21 patients with normal phage had been undergone with anterior cervical artificial disc replacement（without using the anterior cervical plate）.There was statistically significant difference in dysphagia between after application of titanium plate fixation with anterior cervical disc arthroplasty（P=0.0180.018）.There were 3cases in the single-segment group,24 in the two-segment and 36 in multi-segment.There was significant difference between the multi-segment group and the one- or two-segment group（P=3.6×10-（-33）0.05）.Conclusion：There are too many causes of dysphagia after anterior cervical surgery,including female,elder,anterior cerivical plate,multiple surgical segments and so on.So clinicians should concern about the dysphagia following the anterior cervical surgery.