颈椎前路术后吞咽困难的危险因素分析

Risk factors of dysphagia after anterior cervical spine surgery

颈椎前路手术入路自从1958年被Smith和Robinson报道以来,因其安全有效,成为目前治疗各类颈椎疾患（创伤、退行性变、肿瘤、炎症等）最常用的手术方式。随着临床报道逐渐增加,吞咽困难成为颈椎前路术后常见的并发症之一,文献报道其发生率在1.7%～79.0%之间,甚至有部分患者产生长期吞咽困难或者在术后早期发生严重吞咽困难。

Anterior cervical spine surgery（ ACSS） is commonly used in the treatment of numerous cervical disorders, such as traumatic, degenerative, inflammatory or neoplastic diseases. Dysphagia is one of the most common complications after ACSS with reported incidence 1.7%-79.0%. Some patients got persistent dysphagia or severe dysphagia in the early postoperative stage. It has been reported that the risk factors of dysphagia after ACSS included patients＇ factors（ age, gender, BMI, duration of preexisting pain, preoperative comorbidities, smoking, psychological problem）, operation-related factors（ operating time, blood loss, overenlargement of C_（2-7） angle）, surgical type（ multilevel surgery, revision surgery, surgical level at C_（4-5） or C_（5-6）, fusion surgery）, applications during surgery [ use of bone morphogenetic protein（ BMP）, traditional cervical retractor, endotracheal tube cuff pressure（ ETCP） over 20 mm Hg, and thick plate ], prevertebral soft tissue swelling etc.