枕颈融合术后患者枕颈角度与困难气道的关系

Relationship between occipitocervical angle and difficult airway after occipitocervical fusion surgery

目的:评价枕颈融合术后患者颅底枢椎角(O-C_(2)角)、颌-咽夹角(M-P角)和颈椎活动度(CROM)与困难气道的关系。 方法:本研究为回顾性研究。回顾性收集2018年3月至2023年3月于本院行枕颈融合术患者的临床资料。记录患者术前以及末次随访时气道评估资料和颈椎侧位X线片,测量O-C_(2)角、M-P角和CROM。根据末次随访改良Mallampati分级将患者分为阴性组(Mallampati分级Ⅰ或Ⅱ级,无气管插管困难)和阳性组(Mallampati分级Ⅲ或Ⅳ级,可能造成气管插管困难)。 结果:共纳入53例患者,阳性组18例,阴性组35例。53例患者术前与末次随访时O-C_(2)角和CROM比较差异无统计学意义( P>0.05),末次随访时M-P角较术前减小( P<0.05)。与阴性组比较,阳性组末次随访时O-C_(2)角和M-P角减小( P<0.05),CROM差异无统计学意义( P>0.05)。与术前比较,2组末次随访时M-P角减小,阳性组末次随访时O-C_(2)角减小( P<0.05)。O-C_(2)角、M-P角和CROM预测困难气道的受试者工作特征曲线下面积分别为0.895、0.888和0.519。 结论:枕颈融合术后患者O-C_(2)角和M-P角减小可增加困难气道风险,两者可用于该类患者气道评估。

Objective To evaluate the relationship between the occipitocervical angle(basilar vertebral angle[O-C_(2) angle],mento-pharyngeal angle[M-P angle],and cervical range of motion[CROM])and difficult airway after occipitocervical fusion surgery in the patients.Methods This was a retrospective study.The clinical data from patients who underwent occipitocervical fusion surgery at our hospital from March 2018 to March 2023 were retrospectively collected.Preoperative and last follow-up airway assessment data and cervical lateral X-rays were collected to measure the O-C_(2) angle,M-P angle and CROM.Patients were divided into negative group(Mallampati gradeⅠorⅡ,suggesting no difficulty in intubation)and positive group(Mallampati gradeⅢorⅣ,suggesting possible difficulty in intubation)based on the last follow-up modified Mallampati classification.Results A total of 53 patients were finally included,with 18 cases in positive group and 35 in negative group.There were no statistically significant differences in the O-C_(2) angle and CROM between preoperative and last follow-up in the 53 patients(P>0.05),and the M-P angle was significantly decreased at the last follow-up compared with that before operation(P<0.05).Compared with negative group,O-C_(2) angle and M-P angle were significantly decreased at the last follow-up(P<0.05),and no significant change was found in CROM in positive group(P<0.05).Compared with that before operation,the M-P angle was significantly decreased at the last follow-up in both groups,and the O-C_(2) angle was significantly decreased at the last follow-up in positive group(P<0.05).The areas under the receiver operating characteristic curves of O-C_(2) angle,M-P angle and CROM in predicting difficult airway were 0.895,0.888 and 0.519 respectively.Conclusions The decrease in the O-C_(2) angle and M-P angle after occipitocervical fusion surgery can increase the risk of difficult airway,and both can be used for airway assessment in the patients undergoing this kind of surgery.