颈椎前路术术后吞咽困难的预防措施

Preventive measures of dysphagia after anterior cervical spine surgery

颈椎前路手术入路（anterior cervical spine surgery,ACSS）是目前治疗各类颈椎疾患（创伤、退行性变、肿瘤等）最常用的手术方式,而吞咽困难是ACSS术后最常见的并发症之一,大部分文献报道其发生率在1.7%~79%之间,甚至有文献报道其术后早期发生率高达88.8%。

Anterior cervical spine surgery （ ACSS ） is commonly used for the treatment of numerous cervical disorders, such as traumatic, degenerative and congenital diseases. Dysphagia is one of the most common complications after ACSS. The reported risk factors of dysphagia after ACSS included multilevel surgery, revision surgery, gender （ female ）, prolonged operating time, age （ older than 60 y ）, psychological problems, use of BMP or rhBMP, smoking, and change of C2-7 angle etc. Effective preventative measures included preoperative tracheal traction exercises, maintaining of the endotracheal tube cuff pressure at 20 mm Hg, not-prolonged operating time, improved skills of surgeons, non-smoking, avoided routine use of rhBMP-2, avoided overenlargement of cervical lordosis, decreased surgical levels, mastering of anatomy of the superior laryngeal nerve and recurrent laryngeal nerve, and applications of steroid, Zero-profile implant, Zephir plate, new cervical retractor.