颈椎曲度变化与颈椎前路或后路术后吞咽困难的关系  

Relationship between postoperative dysphagia and cervical lordosis change after anterior and posterior cervical spine surgery

作　　者：于杰[1] 陶晓晖[1] YU Jie;TAO Xiaohui(Department of Spine Surgery,Beijing Jishuitan Hospital,Beijing100035,China)

机构地区：[1]北京积水潭医院脊柱外科,北京100035

出　　处：《山东医药》2021年第25期23-26,31,共5页Shandong Medical Journal

摘　　要：目的探讨颈椎曲度变化与颈椎前路或后路术后吞咽困难的关系。方法选择行颈椎手术的脊髓型或神经根型颈椎病患者452例,其中接受颈椎前路减压植骨融合内固定术172例、接受颈后路双开门棘突纵割式椎管扩大人工骨桥成型术182例、接受颈椎前路人工椎间盘置换术98例。通过HSS-DDI量表评估颈椎前路或后路术后是否存在吞咽困难,并按照Bazaz分级系统评估颈椎前路或后路术后吞咽困难程度。根据颈椎前路或后路术后是否发生吞咽困难,将患者分为吞咽困难组与无吞咽困难组,收集两组人口学资料(包括性别、年龄、BMI)、手术相关资料(包括手术时间、术中出血量、是否二次手术、手术节段数目、手术节段是否包含C3/4)、影像学检查资料(dO-C2角、dC2-C7角)。以颈椎前路或后路术后是否发生吞咽困难为因变量,以两组人口学资料、手术相关资料、影像学检查资料中P<0.20的可疑资料为自变量,纳入多因素Logistic回归模型,分析颈椎前路或后路术后发生吞咽困难的危险因素。结果 452例颈椎手术患者术后吞咽困难的发生率为9.73%(44/452)。其中,接受颈椎前路减压植骨融合内固定术者术后吞咽困难的发生率为12.79%(22/172),接受颈后路双开门棘突纵割式椎管扩大人工骨桥成型术者为9.34%(17/182),接受颈椎前路人工椎间盘置换术者为5.10%(5/95)。44例术后吞咽困难患者中,吞咽困难程度轻度17例、中度21例、重度6例。单因素分析发现,性别、手术时间、手术节段数目、dC2-C7角可能与颈椎前路或后路术后吞咽困难有关(P均<0.20),而年龄、BMI、术中出血量、二次手术、手术节段包含C3/4、dO-C2角可能与颈椎前路或后路术后吞咽困难无关(P均>0.20)。多因素Logistic回归分析显示,dC2-C7角是颈椎前路或后路术后吞咽困难的独立危险因素(P<0.01)。结论吞咽困难是颈椎病术后常见的并发症之一,C2-C7�Objective To analyze the relationship between cervical lordosis change and the development of dyspha⁃gia after anterior and posterior cervical spine surgery(ACDF,CDR and PC).Methods Totally 452 patients diagnosed with cervical spondylosis were reviewed in this study,including 172 patients who underwent the ACDF procedure,98 pa⁃tients who received the CDR procedure,and 182 patients who underwent the PC procedure.The presence and degree of postoperative dysphagia were recorded via HSS-DDI and Bazaz dysphagia scale.The patients were divided into two groups depending on the presence of postoperative dysphagia.The demographic data(age,gender,BMI),operative data(opera⁃tive time,blood loss,revision surgery,operative level included C3/4 and number of operative levels),and imaging data(dO-C2 angle,dC2-C7 angle)were collected.Multivariate Logistic regression analysis was also used to investigate the as⁃sociation of postoperative dysphagia,with"dysphagia"as the dependent variable,and the independent variables included the demographic data,operative data,and imaging data whose p-value were less than 0.20 in single factor analysis.Re⁃sults Among 452 patients,12.79%ACDF(22/172),5.10%CDR(5/95),and 9.34%PC(17/182)patients report⁃ed dysphagia after cervical surgery,so that the total incidence was 9.73%.Among these 44 patients who had postoperative dysphagia,17 patients could be graded as"Mild",21 patients could be graded as"Moderate",and 6 patients could be graded as"Severe"dysphagia following the dysphagia grading system defined by Bazaz.Gender,operative time,number of operative levels and dC2-C7 angle were suspicious relevant factors according to the result of single factor analysis(all P<0.20).Age,BMI,blood loss,revision surgery,operative level including C3/4,and dO-C2 angle were not related to post⁃operative dysphagia(all P>0.20).Multivariate Logistic regression analysis showed that dC2-C7 angle was the risk factor for the postoperative dysphagia after anterior and posterior cervical spine surgery(P<0.01).Conclu

关 键 词：颈椎病 吞咽困难 颈椎曲度 C2-C7角 O-C2角 

分 类 号：R681.5[医药卫生—骨科学]