颈椎病经颈椎前路术后吞咽困难的原因分析

Analysis on the causes of dysphagia in cervical spondylosis after anterior cervical spine surgery

目的研究颈椎病经颈椎前路术后吞咽困难的原因。方法回顾性分析2010年7月～2014年6月我科及西南医科大学附属医院脊柱外科186例经颈椎前路固定融合术治疗的颈椎病患者临床资料。收集患者年龄、性别、术式、融合节段、手术时间、失血量及吸烟史。比较不同患者吞咽困难发生率,采用Logistic模型分析术后吞咽困难的原因。结果所有患者切口均一期愈合。术后共有82例(44.1%)出现吞咽困难。单因素分析显示不同性别、年龄、手术方式、吸烟史、术中节段融合情况及高血压病史患者术后吞咽困难发生率比较,差异有统计学意义(P<0.05)。Logistic多因素模型结果显示女性、高龄、ACCF及多节段融合是术后吞咽困难的独立高危因素(P<0.05)。结论高龄、女性、吸烟、使用ACCF术式、多节段融合是颈椎前路融合术后发生吞咽困难的原因。

Objective To study the causes of dysphagia in cervical spondylosis after anterior cervical spine surgery.Methods The clinical data of186patients with cervical spondylosis who were treated by anterior cervical fixation and fusion in our department and the Department of Spinal Surgery of Affiliated Hospital of Southwest Medical University from July2010to June2014were retrospectively analyzed.Patients'age,gender,surgical procedures,fusion segments,time of surgery,blood loss,and smoking history were collected.The incidence rate of dysphagia in different patients was compared,and the Logistic model was used to analyze the causes of postoperative dysphagia.Results The incisions of all patients were undergone first-stage healing.A total of82patients(44.1%)were seen with dysphagia after surgery.Univariate analysis showed that the incidence rate of postoperative dysphagia in patients with different genders,ages,surgical procedures,smoking history,intraoperative segmental fusion,and history of hypertension was statistically significantly different(P<0.05).Logistic multivariate model showed that female,advanced age,ACCF and multi-segment fusion were independent high risk factors for postoperative dysphagia(P<0.05).Conclusion Advanced age,female,smoking,ACCF procedure,and multi-segment fusion are the causes of dysphagia after anterior cervical spine fusion.