全身麻醉经口气管插管下颈椎后路手术后Tapia综合征的发生及其相关因素

The incidence and causes of Tapia syndrome after posterior cervical spine surgery under oral tracheal intubation general anesthesia

目的分析全身麻醉经口气管插管下行颈椎后路手术后出现Tapia综合征的发生率及相关的危险因素。方法回顾性分析2018年6月至2021年5月北京大学第三医院骨科在全身麻醉经口气管插管下行颈椎后路手术后出现Tapia综合征的脊髓型颈椎病和颈椎后纵韧带骨化症患者的临床资料。选取相同手术类型、主刀医生、年龄及性别作为匹配因素,每个病例选择4例未发生Tapia综合征的患者作为对照组。在颈椎侧位X线片上测量下颌骨‑椎体距离、舌骨‑椎体距离、甲状软骨‑椎体距离、C_(2)‑C_(7)前凸Cobb角。分别在中立位、过屈位和过伸位X线片上测量上述参数。分析发病组及对照组在上述参数的差异。结果在2431例全身麻醉经口气管插管下行颈椎后路手术患者中,9(0.37%)例出现Tapia综合征,其中男3例,女6例,年龄(61±5)岁,症状平均发生在术后0.67 d(0~2 d)。临床表现为:伸舌偏移8例(8/9,88.9%),构音障碍6例(6/9,66.7%),吞咽困难3例(3/9,33.3%),舌头不灵活3例(3/9,33.3%),声音嘶哑及咽部不适各1例(1/9,11.1%)。所有患者在术后3个月复查时,上述所有症状均缓解。颈椎中立位时,下颌骨‑椎体前缘的距离对照组为(7.19±3.96)mm,Tapia组为(3.98±3.01)mm,差异有统计学意义(P<0.05)。下颌骨‑椎体距离由中立位至过屈位时:Tapia组由3.98 mm降至1.95 mm,降幅为51.0%,而对照组由7.19 mm降至4.90 mm,降幅为31.8%。结论经口气管插管全身麻醉下颈后路术后Tapia综合征发生率低。术前中立位颈椎X线片下颌骨‑椎体前缘距离较小可能是经口气管插管全身麻醉下颈后路术后发生Tapia综合征的危险因素。

Objective To observe the incidence of Tapia syndrome after posterior cervical spine surgery under oral tracheal intubation general anesthesia and to explore the risk factors for its occurrence.Methods The data of patients suffered from Tapia syndrome after posterior cervical spine surgery under oral tracheal intubation general anesthesia from June 2018 to May 2021 were retrospectively reviewed.The type of procedure,surgeon,age and gender were selected as matching factors,4 patients without Tapia syndrome were selected as control group for each case.The radiological parameters including mandibular‑vertebral distance,thyroid‑vertebral distance,thyroid cartilage‑vertebral distance,and C_(2)‑C_(7) lordotic Cobb angle were measured on lateral radiographs of the cervical spine.The above parameters were measured on neutral,over‑flexion and over‑extension radiographs.The difference between the Tapia group and the control group were analyzed.Results There were 9 patients(0.37%)suffered from Tapia syndrome after posterior cervical spine surgery under oral tracheal intubation general anesthesia in 2431 patients,and it happened in 0.67 days(0‑2 days)after the operation.There were 3 males and 6 females with a mean age of(61±5)years.The clinical manifestations was tongue extension deviation in 8 cases(88.9%),dysarthria in 6 cases(66.7%),dysphagia in 3 cases(33.3%),tongue stiffness in 3 cases(33.3%),hoarseness in voice and pharyngeal discomfort in 1 case(11.1%).All of the symptoms were relieved in all patients at 3 months postoperative follow‑up.In neutral position,the mandibular‑vertebral distance was(7.19±3.96)mm in the control group and it was(3.98±3.01)mm in Tapia group(P<0.05).From neutral position to hyperflexion position,the distance between mandible and vertebral body was reduced from 3.98 mm to 1.95 mm in the Tapia group and decreased for 51.0%,and it decreased from 7.19 mm for 31.8%to 4.90 mm in the control group.Conclusions The incidence of Tapia syndrome after posterior cervical spine surgery under oral tracheal intubation general anesthesia is low.A smaller mandibular‑vertebral distance on pre‑operative cervical spine lateral view radiograph maybe a risk factor for Tapia syndrome after posterior cervical surgery under oral tracheal intubation general anesthesia.