TARP内固定术后椎前软组织肿胀特征及临床意义

Characteristics and clinical significance of prevertebral soft tissue swelling after TARP internal fixation

目的探讨经口寰枢椎复位钢板(TARP)内固定术后椎前软组织(PVST)肿胀的特征及临床意义。方法回顾性分析施行TARP内固定术(TARP内固定组)、C3/4前路减压椎体内固定手术(C3/4减压组)及C5/6前路减压椎体内固定手术(C5/6减压组)3组患者的临床资料,每组32例。记录患者性别、年龄、身高、体质量、病因、美国脊髓损伤协会(ASIA)分级、手术前后白细胞(WBC)及白蛋白(ALB)、手术时间、术中出血量、补液量、拔管时间,记录术后再插管和吞咽困难例数。测量患者术前及术后3 d C2~C43个节段的PVST厚度。结果与C3/4减压组、C5/6减压组比较,TARP内固定组患者以女性居多、均由疾病所致、平均身高较矮、ASIA D级占比多、手术时间长、拔管延迟、术后WBC显著较高,差异具有统计学意义(P<0.05);而3组患者年龄、体质量、术中出血量及补液量、手术前后ALB水平比较,差异无统计学意义(P>0.05)。3组患者均未出现术后再插管及吞咽困难。术前3组患者PVST厚度差异无统计学意义(P>0.05)。术后3 d 3组患者C2~C43个节段的PVST厚度均显著大于术前(P<0.05),且TARP内固定组C2~C43个节段的PVST厚度增幅显著大于C3/4减压组、C5/6减压组(P<0.05),增幅为后2组的1.29~2.5倍。结论TARP内固定术后3 d C2~C43个节段的PVST仍呈现明显肿胀,厚度显著大于C3/4及C5/6前路减压椎体内固定手术患者,术后需加强气道管理,严格掌握拔管指征,严防PVST肿胀导致的气道梗阻和吞咽困难等并发症。

Objective To explore characteristics and clinical significance of prevertebral soft tissue(PVST)swelling after transoral atlantoaxial reduction plate(TARP)internal fixation.Methods Clinical data of patients in 3 groups who received TARP internal fixation(TARP internal fixation group),C3/4 anterior decompression and internal fixation(C3/4 decompression group),and C5/6 anterior decompression and internal fixation(C5/6 decompression group)respectively were retrospectively analyzed,with 32 cases in each group.The gender,age,height,body mass,cause of disease,American Spinal Injury Association(ASIA)grade,levels of white blood cells(WBC)and albumin(ALB)before and after operation,operation time,intraoperative blood loss,volume of fluid resuscitation,and extubation time,and patients reintubation and dysphagia after operation were recorded.The thickness of PVST at 3 segments from C2 to C4 was measured before operation and 3 days after operation.Results Compared with the C3/4 decompression group and the C5/6 decompression group,the majority of patients in the TARP internal fixation group were women and all of which were caused by diseases.And patients in the TARP internal fixation group had shorter average height,higher proportion of ASIA D grade,longer operation time,later extubation,and significantly higher level of postoperative WBC,and the differences were statistically significant(P<0.05);whereas there were no statistically significant differences in age,body mass,intraoperative blood loss and volume of fluid resuscitation,ALB level before and after operation among the 3 groups(P>0.05).There was no reintubation or dysphagia cases after operation in the 3 groups.There was no statistically significant difference in the thickness of PVST among the 3 groups before operation(P>0.05).The thicknesses of PVST from C2 to C4 segments in the 3 groups 3 days after operation were significantly greater than those before operation(P<0.05),and the increasing range of PVST thickness from C2 to C4 segment in the TARP internal fixation group was significantly higher than that in the C3/4 decompression group and the C5/6 decompression group,which was 1.29 to 2.5 times of the latter two groups(P<0.05).Conclusion Postoperative airway management and extubation indications should be strengthened to prevent complications such as airway obstruction and dysphagia caused by PVST swelling since the PVST of C2 to C4 segments still showed significant swelling at 3 days after TARP internal fixation,and the thickness was significantly greater than that of C3/4 and C5/6 anterior decompression internal fixation group.