枕颈融合术后吞咽困难的相关因素分析

Factors related to dysphagia secondary to occipitocervical instrumented fusion

目的]探讨枕颈融合术后出现吞咽困难的相关危险因素。[方法]回顾性分析2013—2019年苏州大学附属第二医院行枕颈融合术的33例患者病例资料。根据术后是否发生吞咽困难分为两组,单因素分析比较两组间各指标的差异;以是否出现吞咽困难作为因变量,其他因素为自变量进行多元逻辑回归分析;采用Pearson分析术后与术前枕颈角(occipital-cervical 2 angle,O-C_(2))的差值d O-C_(2)与口咽部气道最窄距离(the narrowest oropharyngeal airway space,n PAS)差值(dn PAS)及和差值变化率(dn PAS%)的相关性。[结果]33例患者中,共有5例患者出现吞咽困难症状,发生率为15.15%,其中轻度吞咽困难2 例,中度吞咽困难3例。单项因素比较,吞咽困难组的d O-C_(2)和dn PAS显著低于非吞咽困难组(P<0.05),但是两组在年龄、性别、术中出血量、手术时间、BMI、Pre O-C_(2)、Pren PAS、Pre C_(2-7)、Po O-C_(2)、Pon PAS、Po C_(2-7)和d C_(2-7)和差异均无统计学意义(P>0.05)。二元多因素逻辑回归分析显示,dn PAS (OR=0.425,P=0.038)是术后吞咽困难发生的独立保护性因素。Pearson线性分析结果显示,dn PAS与d O-C_(2)呈正相关性(r=0.806,P<0.001),dn PAS%与d O-C_(2)呈正相关性(r=0.460,P<0.001)。[结论]吞咽困难是枕颈融合术后较常见的并发症之一,dn PAS增大的患者术后不易发生吞咽困难。

[Objective] To explore the risk factors of dysphagia secondary to occipitocervical instrumented fusion. [Methods] A retrospective study was conducted on 33 patients who underwent occipitocervical fusion in our hospital from 2013 to 2019. Based on whether or not dysphagia occurred after operation, the patients were divided into two groups. The univariable analysis was done to compare the difference in each item between the two groups. In addition, a binary multiple logistic regression was conducted to search the independent factor s related to postoperative dysphagia by using whether or not dysphagia happened as the dependent variable and other factors as independent variables. Pearson linear analysis was performed to search the correlations between the post-preoperative difference of occipital-cervical 2 angle(dO-C_(2)) and the narrowest oropharyngeal airway space((dnPAS), as well as the variation ratio of the latter(dnPAS%). [Results] Of the 33 patients, 5 patients had symptomatic dysphagia, accounted for 15.15%, including mild dysphagia in 2 cases and moderate dysphagia in 3 cases. In terms of univariable comparison, the dysphagia group had significantly less dO-C_(2) and dnPAS than the non-dysphagia group(P<0.05), but no statistically significant differences were noted in age, gender, intraoperative blood loss, operation time, BMI, PreO-C_(2),PrenPAS, PreC_(2-7), PoO-C_(2), PonPAS, PoC_(2-7) and dC_(2-7) between the two groups(P>0.05). As result of binary multivariate logistic regression, the dnPAS(OR=0.425, P=0.038) was an independent protective factor for postoperative dysphagia. The Pearson linear analysis showed that dnPAS was positively correlated with dO-C_(2)(r=0.806, P<0.001), and dnPAS% was positively correlated with dO-C_(2)(r=0.460,P<0.001). [Conclusion] Dysphagia is one of common complications after occipitocervical fusion, whereas the patients with enlarged dnPAS are less likely to have dysphagia.