单节段颈椎前路术后吞咽困难的危险因素研究  

Risk factors of dysphagia after single-level anterior cervical surgery

作　　者：闫锁洲 王晓宇[2] 孔令德[1] 邸军[1] 丁文元[1] 张静涛[1] 杨思东[1] 李嘉[1] 王林峰[1] 申勇[1] 

机构地区：[1]河北医科大学第三医院脊柱骨科,石家庄050051 [2]石家庄市第一医院老年病1科,050051

出　　处：《中华骨科杂志》2018年第2期65-71,共7页Chinese Journal of Orthopaedics

摘　　要：目的探讨单节段颈椎前路术后吞咽困难的发生率及其潜在危险因素。方法回顾性分析2014年1月至2015年12月187例行单节段颈椎前路手术患者的病例资料，男117例，女70例；年龄19-78岁，平均49．71岁。采用颈椎前路减压融合术139例，颈椎间盘置换术48例。并记录术前、术后1周和术后1、3、6、12个月时患者的年龄、性别、体重指数、吸烟和饮酒史、手术时间、术中失血量、手术节段、切口长度、住院时间、术前气管锻炼情况、手术方式、颈椎曲度变化等资料。采用Bazaz评分系统和吞咽困难生活质量量表（swallowing quality of life，SWAL—QOL）评估吞咽困难的存在和严重性。根据术后1周患者Bazaz评分分为吞咽困难组和非吞咽困难组，通过单因素Х^2检验及单样本t检验分别对两组相关因素进行单因素分析，选取潜在变量进行多因素logistic回归分析，以明确导致吞咽困难的危险因素。结果术后1周，出现吞咽困难者99例（52．94％），术后1年16例（8．56％）。术前SWAL-QOL评分为（65．62±4．41）分，术后下降至（58．72±7．54）分，术后1年为（64．66±5．26）分。术后1周SWAL-QOL评分与手术时间相关（r=0．474，P〈0．001）。多因素分析显示患者术前气管锻炼（OR=0．302，95％CI：0．131，0．748）、手术时间〈60min（OR=0．407，95％CI：0．190，0．878）和人工颈椎间盘置换术（OR=O．211，95％CI：0．102，0．425）是降低术后吞咽困难发生率的独立相关因素。结论单节段颈椎前路术后吞咽困难症状的发生率和严重程度随着随访时间的延长逐渐降低，术前气管锻炼、缩短手术时间、行人工间盘置换术这些因素可能有助于减少术后吞咽困难的发生。Objective To explore the incidence of dysphagia and its potential risk factors. Methods From January 2014 to December 2015, a total of 187 patients who underwent single-level anterior cervical spine surgery were recruited in this retrospective analysis study. Specific perioperative data including age, gender, smoking, alcohol use, BMI, estimated blood loss, surgical segment, length of incision, and length of hospital stay were recorded respectively. The Bazaz grading system and the swallowing quality of life （SWAL-QOL） score were used to assess the presence and severity of dysphagia. According to the Bazaz grading system, the patients were divided into dysphagia group and non-dysphagia group 1 week after operation. One-factor Х^2 test and one-sample t test were used to univariate analyze the two groups of related factors, and select the potential variables for multivariate logistic regression analysis to identify the risk factors leading to dysphagia. Results The number of dysphagia patient was 99 （52.94%） at 1 week after surgery, and 16 （8.56%） at 1 year. The preoperative mean SWAL-QOL score was 65.62±4.41 points, which decreased to 58.72±7.54 points after surgery and rose up to 64.66±5.26 points at the 12-month follow-up. The SWAL-QOL score at 1 week after surgery was correlated with the operative time （r=-0.474; P 〈 0.001）. Multivariate analysis indicated that preoperative tracheal exercise （OR=0.302, 95%CI： 0.131, 0.748）, operation time 〈 60 min （OR=0.407, 95%CI： 0.190, 0.878）, and arthroplasty （OR=0.211, 95% CI： 0.102, 0.425） were the independent factors to reduce the incidence of postoperative dysphagia. Conclusion The incidence and severity of dysphagia symptoms after single-level anterior cervical spine surgery gradually decreased with the extension of follow-up time. Preoperative tracheal exercise, shortened operative time and manual artificial disc replacement may be helpful to reduce the postoperative occurrence of dysphagia.

关 键 词：颈椎 脊柱融合术 全椎间盘置换 吞咽障碍 危险因素 

分 类 号：R687.3[医药卫生—骨科学]