颈前路减压术中入路选择对术后吞咽困难的影响  

Effect of surgical approach on the degree of postoperative dysphagia in anterior cervical decompression surgery

作　　者：陈怀志[1] 胡成栋[1] 霍喜卫[1] 任冬云 

机构地区：[1]河北省邯郸市中心医院,河北邯郸056001 [2]河北省邯郸县妇幼保健院,河北邯郸056001

出　　处：《现代中西医结合杂志》2014年第32期3541-3543,共3页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：河北省科技计划项目(12277750)

摘　　要：目的观察颈前路减压术中经肩胛舌骨肌内侧缘和外侧缘入路对术后患者吞咽困难的影响。方法将80例接受前路减压手术治疗的患者随机分为2组,手术均采用标准的Smith-Robinson入路,内侧组术中经肩胛舌骨肌内侧缘显露椎体,外侧组经外侧缘显露椎体。在术前及术后1周、3周、6周、12周及6个月时,以吞咽-生活质量问卷对患者的吞咽功能进行评分比较。结果 2组吞咽评分在各随访时间点的差异未见统计学意义(P均>0.05)。然而,对于在C3—5节段行手术的患者,内侧组在术后1,3周时的评分明显低于外侧组(P均<0.05),而在C5—7节段行手术的患者,内侧组在1,3周时评分明显高于外侧组(P均<0.05)。结论颈椎前路减压术中,手术入路的选择对术后吞咽困难程度有一定影响;当行C3—5节段手术时,肩胛舌骨肌外侧入路应作为首选;当行C5—7节段手术时,肩胛舌骨肌内侧入路为首选。Objective It is to observe the effect of approaches carried out lateral or medial to the omohyoid muscle in anterior cervical decompression surgery on the degree of postoperative dysphagia. Methods 80 patients underwent two-level anterior cervical decompression and fusion surgery using a standard Smith-Robinson approach,and were evenly divided into the two groups according to the surgical approach： medial group or lateral group. Follow-up was obtained 1,3,6,12 week and 6months after surgery. The degree of dysphagia was assessed using a 14- item questionnaire from the SWAL- QOL survey.Results The SWAL- QOL scores were not different between the two groups at any of the follow- up time points（ P〉 0. 05）.However,when the level of surgery was taken into consideration,the 1- week and 3- weeks postoperative SWAL- QOL scores were significantly lower in the C3—5patients in medial group compared with that in lateral group（ P 〈0. 05）. Conversely,the SWAL- QOL scores were significantly lower in the C5—7patients in lateral group compared with that in medial group（ P〈 0. 05）. Conclusion The anterior surgical approach of cervical spine may have an effect on the degree of postoperative dysphagia in anterior cervical decompression surgery. The lateral approach should be selected if the level of surgery involves C3—5.However,for two-level surgery of C5—7,a medial approach is a better choice.

关 键 词：颈前路手术 并发症 吞咽困难 肩胛舌骨肌 

分 类 号：R687.3[医药卫生—骨科学]