颈椎前路术后吞咽困难相关因素的探讨

Role of C2-C7 angle in the development of dysphagia after anterior cervical spine surgery

目的探讨颈椎前路手术后整体曲度变化与术后吞咽困难症状的关系。方法2007年6月至2010年5月,在北京积水潭医院脊柱外科行颈前路减压钢板内固定术患者共198例,能完成术后至少1年随访的病例共172例(ACDF组)。在同一时间段内,有154例患者行颈前路人工椎间盘置换术,能完成术后至少1年随访的共98例(CDR组)。参与本研究的270例患者均通过电话随访填写调查问卷,调查涉及的问题主要包括术后是否出现吞咽困难、出现时间、严重程度、缓解情况、治疗方案等。所有入选的患者最终随访时间均>1年。将患者划分为吞咽困难组及对照组,分别对两组患者的术前后C2-C7角度变化以及其余可能相关因素进行研究。结果12.8%的ACDF组患者以及5.1%的CDR组患者术后出现吞咽困难症状。二元Logistic回归模型分析显示,手术前后C2-C7角度变化可以显著影响吞咽困难症状的发生(β=0.132,OR=1.141,P=0.001),而患者的性别、年龄、身体质量指数、手术时间、出血量、手术方式(融合/非融合)、初次手术比例(翻修比例)、手术包含节段数目、是否包含C3节段等均不是发生术后吞咽困难的危险因素(均P>0.05)。手术C2-C7角度变化的大小与吞咽困难的严重程度没有线性关系。术后出现吞咽困难的患者1年之内大都能够彻底痊愈。结论颈椎术后吞咽困难是常见的手术并发症之一。C2-C7曲度变化是颈椎术后吞咽困难发生的重要影响因素。吞咽困难症状往往可在术后1年之内得到彻底缓解。

Objective To analyze the relationship between cervical lordosis and the development of dysphagia after anterior cervical spine surgery.Methods From June 2007 to May 2010,270 cases were reviewed in this study,including cases of 172 patients undergoing anterior cervical decectomy and fusion(ACDF)procedure,and 98 patients undergoing cervical disc replacement(CDR)procedure in Department of Spine Surgery,Beijing Jishuitan Hospital.All patients were divided into dysphagia group and the control group.The presence and duration of postoperative dysphagia was recorded via face-to-face questioning or telephone interview performed at least one year after the procedure.Plain cervical radiographs before and after surgery were collected.The C2-C7 angle were measured.Results 12.8%ACDF and 5.1%CDR patients reported dysphagia after cervical surgery.dC2-C7 angle has considerable impact on postoperative dysphagia(β=0.132,OR=1.141,P=0.001).Analysis of Bivariate Logistic Regression Mode showed that ge,gender,BMI,operative time,blood loss,procedure type,revision surgery,C3 included,most cephalic operative level and number of operative levels did not significantly influence the incidence of postoperative dysphagia(β=0.132,OR=1.141,P=0.001).No relativity was found between dC2-C7 angle and the degree of dysphagia.The postoperative dysphagia could disappear in one year after the procedure.Conclusions Postoperative dysphagia is common after cervical surgery.dC2-C7 angle may play an important role in the development of dysphagia both in anterior and posterior cervical spine surgery.Postoperative dysphagia would disappear in one year after spine surgery.