颈椎前路手术术中应用可吸收胶原生物膜对术后吞咽功能改善的影响  

Effect of absorbable collagen bio-membrane used in the anterior cervical spine surgery on swallowing function

作　　者：黄康康 邓宇骁[1] 丁琛[1] 王贝宇[1] 陈华[1] 戎鑫[1] 马立泰[1] 洪瑛[2] 刘浩[1] Huang Kangkang;Deng Yuxiao;DinE Chen(Department of Orthopedics;Operating Room,West China Hospital,Sichuan University,Chengdu Sichuan,610041,China)

机构地区：[1]四川大学华西医院骨科,四川成都610041 [2]四川大学华西医院手术室,四川成都610041

出　　处：《生物骨科材料与临床研究》2018年第5期31-34,共4页Orthopaedic Biomechanics Materials and Clinical Study

基　　金：四川省科技计划项目(2016FZ0083)

摘　　要：目的探索可吸收胶原生物膜对颈椎前路术后吞咽困难功能的影响,改进手术细节,提高患者术后生活质量。方法采用前瞻性的对照研究方法,自2016年3月始,将于华西医院骨科住院拟行颈椎前路连续双节段椎间融合(Zero-P假体)的患者分为实验组和对照组,每组入选20例,对照组在植入颈椎假体后常规缝合椎前筋膜;实验组在常规缝合椎前筋膜的基础上于椎前软组织间隙放置可吸收胶原生物膜。术后3天、3月、6月于颈椎侧位X线片上测量手术节段椎前软组织(PST)厚度以判断椎前软组织肿胀情况,并完善Bazaz吞咽困难评价标准和吞咽-生活质量(SWAL-QOL)问卷调查以评估吞咽功能。结果术后3天实验组与对照组PST肿胀分别为(0.59±0.38)cm和(0.63±0.3)cm,差异无统计学意义(P>0.05),术后3个月、6个月实验组与对照组PST肿胀分别为(0.19±0.12)cm和(0.43±0.35)cm、(0.2±0.12)cm和(0.4±0.31)cm,差异均有统计学意义(P<0.05)。术后3天、6个月实验组与对照组SWAL-QOL问卷评分分别为62.05±1.57和61.26±1.48、68.75±1.33和68.05±1.47,无明显统计学差异(P>0.05),而术后3个月实验组与对照组SWAL-QOL问卷评分分别为65.9±1.41和63.47±1.35,差异具有统计学意义(P<0.05)。术后3天、6个月实验组与对照组吞咽困难总体发生率分别为35%和55%、10%和20%,差异无明显统计学意义(P>0.05),而术后3个月实验组与对照组吞咽困难总体发生率分别为15%和45%,差异具有明显统计学差异(P<0.05)。结论术中应用可吸收胶原生物膜能够在ACSS术后早期降低吞咽困难总体发生率,在极早期可以预防中度及以上吞咽困难的发生。Objective To investigate the change of swallowing function after using absorbable collagen bio-membrane during the anterior cervical spine surgery（ACSS） for improving the detail of surgery and the quality of life after surgery.Methods A prospective controlled study was made to select the data of patients who underwent double-level anterior cervical decompression and fusion with Zero-P implant in West China Hospital after March 2016. The patients were divided into experimental group and control group with 20 cases for each one. The absorbable collagen bio-membrane was used after suturing the prevertebral fascia on the experimental group, however the control group was sutured the prevertebral fascia only. The thickness of prevertebral soft tissue（PST） was measured on the lateral X-ray to determine the extent of swelling at 3 days, 3 and 6 months postoperatively. Also, the Bazaz grading system and the Swallowing-Quality of Life（SWAL-QOL） survey was used to assess the swallowing function at each time. Results The extent of PST swelling of experimental group and control group was（0.59±0.38） cm and（0.63±0.3） cm at 3 days with no significant difference（P〉0.05）. However, the one of experimental group and control group at 3 and 6 months was（0.19±0.12） cm and（0.43±0.35） cm,（0.2±0.12） cm and（0.4±0.31） cm with significant difference for both（P〈0.05）. The SWAL-QOL survey of experimental group and control group at 3 days and 6 months was 62.05±1.57 and 61.26±1.48, 68.75±1.33 and68.05±1.47 with no significant difference for both（P〈0.05）, but the one of experimental group and control group at 3 months was 65.9±1.41 and 63.47±1.35 with significant difference（P〈0.05）. The total incidence of dysphagia in experimental group and control group at 3 days and 6 months was 35% and 55%, 10% and 20% with no significant difference（P〉0.05）, but the incidence of experimental group and control group at 3 months was 15% and 45% with significant difference（P〈0.05�

关 键 词：颈前路手术 吞咽困难 可吸收胶原生物膜 椎前软组织肿胀 吞咽-生活质量问卷 

分 类 号：R681.5[医药卫生—骨科学]