基于枕颈影像参数的枕颈融合术后吞咽困难风险分析

Riskanalysis of dysphagia after occipitocervical fusion based on occipitocervical imaging parameters

目的基于枕颈影像参数探讨枕颈融合术后吞咽困难的危险因素。方法选择2018年8月~2020年8月本科收治的84例枕颈交界区不稳患者,均采用枕颈融合术治疗,调查其术后吞咽困难发生情况,设为吞咽困难组及吞咽正常组;比较两组治疗前后的枕颈影像参数,即治疗前后Oc-Ax角、O-C_(2)角、O-EA角以及nPAS以及变化值,并采用多因素Logistic回归分析调查枕颈融合术后吞咽困难的危险因素。结果术后25例发生吞咽困难;吞咽困难组与吞咽正常组的术前、术后1年O-C_(2)角以及ΔO-C_(2)角差异有统计学意义(P<0.05);两组术前Oc-Ax角、O-EA角以及nPAS差异无统计学意义(P>0.05),两组术后1年Oc-Ax角、O-EA角、nPAS以及各指标的变化值差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,ΔO-C_(2)角≤-5°、术后Oc-Ax角≤65°、术后nPAS≤10 mm、术后O-EA角≤100°是枕颈融合术后吞咽困难的危险因素。结论枕颈交界区不稳患者采用枕颈融合术治疗后吞咽困难发生率较高,O-C_(2)角变化值较大和术后Oc-Ax角、nPAS、O-EA角过小均会增加吞咽困难的风险。

Objective To explore the risk factors for dysphagia after occipitocervical fusion based on occipitocervical imaging parameters.Methods Eighty-four patients with occipitocervical junction zone instability from August 2018 to August 2020 were selected,and all patients were treated with occipitocervical fusion.The occurrence of postoperative dysphagia was investigated,and the patients were divided into the dysphagia group and the normal swallowing group.Occipitocervical imaging parameters,i.e.,Oc Ax angle,O-C2 angle,O-EA angle,and nPAS as well as change values before and after treatment were compared between the two groups.And the risk factors of dysphagia after occipitocervical fusion were investigated by using multivariate logistic regression analysis.Results Dysphagia occurred in 25 patients after occipitocervical fusion in 84 patients.The differences of O-C_(2)angle andΔO-C_(2)angle between dysphagia group and swallowing normal group were statistically significant at preoperation and postoperative 1-year(P<0.05).The preoperative Oc-Ax angle,O-EA angle and nPAS between the dysphagia group and the swallowing normal group showed no significant differences(P>0.05).At postoperative 1-year,the changes of Oc-Ax angle,O-EA angle and nPAS had significant differences between the two groups(P<0.05).Multivariate logistic regression analysis revealed thatΔO-C_(2)angle≤5°,postoperative Oc-Ax angle≤65°,postoperative nPAS≤10 mm,and postoperative O-EA angle≤100°were risk factors for dysphagia after occipitocervical fusion.Conclusion The incidence of dysphagia is high after treatment with occipitocervical fusion in patients with instability of the occipitocervical junction region,the larger change value of the O-C_(2)angle,and the small postoperative Oc-Ax angle,nPAS,and O-EA angle can increase the risk of dysphagia.