单节段颈前路减压椎间融合治疗后发生吞咽困难的相关因素  

Related factors for dysphagia after single-level anterior cervical descectomy and fusion

作　　者：陆英杰[1] 鲍卫国 邹俊[1] 周峰[1] 姜为民[1] 杨惠林[1] 张志明[1] 朱雪松[1] Lu Ying-jie;Bao Wei-guo;Zou Jun;Zhou Feng;Jiang Wei-min;Yang Hui-lin;Zhang Zhi-ming;Zhu Xue-song(Department of Orthopedics,First Affiliated Hospital of Soochow University,Suzhou 215006,Jiangsu Province,China)

机构地区：[1]苏州大学附属第一医院骨科,江苏省苏州市215006

出　　处：《中国组织工程研究》2018年第7期1026-1031,共6页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金(81772358);国家高技术研究发展计划(863计划)(2015AA020316)~~

摘　　要：背景:颈前路减压椎间融合术后患者有很高的吞咽困难发生率,其发病原因可能与多种因素有关,具体发生机制仍不清楚。目的:研究单节段颈前路减压椎间融合术后吞咽困难的相关因素。方法:回顾性分析苏州大学附属第一医院2011年1月至2015年1月因颈椎间盘退行性疾病接受单节段颈前路椎间融合术的病例,住院期间记录患者的基本信息以及手术相关资料,包括手术时间、术中失血量、手术节段、内固定装置以及有无使用重组人骨形态发生蛋白2等。术前和术后第3天测量颈椎曲度以及各节段椎前软组织肿胀程度。术后1,3,6,12,24个月用Bazaz吞咽功能评分系统分别对患者的吞咽情况进行评估。结果与结论:纳入接受单节段颈前路椎间融合术的患者262例,术后1,3,6,12,24个月吞咽困难发生率分别为35.9%,22.9%,15.6%,11.5%,9.2%。单因素分析结果显示性别、手术时间以及病程长短与术后吞咽困难发生相关。Logistic多因素回归分析结果显示手术时间(≥3 h)、女性和病程长短(≥8个月)为单节段颈前路椎间融合术后吞咽困难的危险因素。其中手术时间和女性可能与术后早中期吞咽困难相关,而病程可能与术后慢性吞咽困难相关。椎前软组织肿胀厚度等其他因素与单节段颈前路减压椎间融合术后吞咽困难没有相关性。对于多节段融合术后吞咽困难的风险因素还应进一步研究。BACKGROUND:Patients with anterior cervical discectomy and fusion have a high incidence of dysphagia,which may be associated with a variety of factors.The specific mechanism remains unclear.OBJECTIVE:To explore the related factors of dysphagia after single-level anterior cervical discectomy and fusion.METHODS:We retrospectively analyzed patients with cervical degenerative disc disease receiving single-level anterior cervical discectomy and fusion in First Affiliated Hospital of Soochow University from January 2011 to January 2015.During hospitalization,basic patient data and surgery-related data were recorded,including operation time,intraoperative blood loss,surgical segment,internal fixation device and the use of recombinant human bone morphogenetic protein-2.The cervical alignment and prevertebral soft tissue swelling were measured preoperatively and 3 days postoperatively.At 1,3,6,12,and 24 months postoperatively,the Bazaz swallowing function scoring system was used to assess the swallowing of the patients.RESULTS AND CONCLUSION:A total of 262 patients undergoing single-level anterior cervical discectomy and fusion were involved.The incidence of dysphagia at 1,3,6,12,and 24 months postoperatively was 35.9%,22.9%,15.6%,11.5%and 9.2%respectively.Univariate analysis showed that gender,operation time and course length were associated with postoperative dysphagia.Logistic multivariate regression analysis showed that the duration of operation(≥3 hours),female and course length(≥8 months)were risk factors for dysphagia after anterior cervical descectomy and fusion.Operation time and female may be associated with early and middle dysphagia postoperatively,and the course length may be associated with chronic dysphagia.Prevertebral soft tissue swelling and other factors are not related to dysphagia after single-level anterior cervical discectomy and fusion.Risk factors for dysphagia after multi-level fusion should be further studied.

关 键 词：颈椎 脊柱融合术 手术后并发症 吞咽困难 组织工程 

分 类 号：R318[医药卫生—生物医学工程]