枕颈融合术后吞咽困难评估及预测方法的研究进展  

Research progress on evaluation and prediction methods of dysphagia after occipitocervical fusion

作　　者：倪励斌 陆逊 夏威夷 王向阳[1] Ni Libin;Lu Xun;Xia Weiyi;Wang Xiangyang(Department of Orthopaedics,the Second Affiliated Hospital(Yuying Children's Hospital)of Wenzhou Medical University,Wenzhou 325000,China)

机构地区：[1]温州医科大学附属第二医院(育英儿童医院)骨科,温州325000

出　　处：《中华骨科杂志》2024年第1期53-57,共5页Chinese Journal of Orthopaedics

摘　　要：枕颈融合术(occipitocervical fusion,OCF)用于治疗因各种原因(创伤、类风湿关节炎、感染、肿瘤、先天畸形和退化等)导致的颅颈交界不稳定。通过OCF可获得满意的融合率并重建枕颈稳定性。吞咽困难为OCF术后常见的并发症,严重影响患者术后的生活质量。对吞咽困难的评估主要采用Bazaz吞咽困难评分、吞咽生存质量量表(swallowing quality of life,SWAL-QOL)及进食评估问卷调查表-10(eating assessment tool-10,EAT-10)评分,而临床主要通过颈椎曲度相关参数(O-C2角、O-EA角、Oc-Ax角、PI角)的变化预测吞咽困难的发生。目前,临床评估及预测吞咽困难的方法很多,但最佳评估方法尚不确定。本文对OCF术后吞咽困难的评估及预测方法进行综述,显示Bazaz吞咽困难评分、SWAL-QOL评分及EAT-10评分量表评估OCF术后吞咽困难具有良好的适用性,而在OCF术中通过调整使O-C2角>-5°、O-EA角>100°、Oc-Ax角>65°、术后PI角较术前PI角增加(即dPI角)≥0°,可在一定程度上减少吞咽困难发生的概率。Occipitocervical fusion(OCF)is used to treat the instability of the cranio-cervical junction due to various reasons(such as trauma,rheumatoid arthritis,infection,tumor,congenital malformations and degeneration).A satisfactory fusion rate can be obtained and the stability of the occipital neck can be reconstructed by OCF.Dysphagia is one of the most common complications after OCF,which seriously affects the quality of life of patients after surgery.This article mainly focuses on the evaluation and prediction methods of dysphagia after OCF,and summarizes related research in the past 16 years,and provides guidance and direction for how to predict the occurrence of dysphagia during OCF and the evaluation of postoperative dysphagia.The evaluation of dysphagia is mainly conducted using the Bazaz dysphagia score,swallowing quality of life scale(SWAL-QOL)and eating assessment tool-10(EAT-10)score.However,the clinical prediction of dysphagia is mainly based on the changes of cervical curvature parameters(O-C2 angle,O-EA angle,Oc-Ax angle,PI angle).At present,there are many methods for clinical evaluation and prediction of dysphagia,but the best evaluation method is still uncertain.We reviews the evaluation and prediction methods of postoperative dysphagia of OCF,showing that the Bazaz dysphagia score,SWAL-QOL score and EAT-10 score scale are suitable for evaluating postoperative dysphagia of OCF.During OCF operation,adjustment of O-C2 Angle>-5°,O-EA Angle>100°,Oc-Ax Angle>65°,and increase of postoperative PI Angle from preoperative PI Angle(that is,dPI Angle)≥0°can reduce the probability of dysphagia to a certain extent.

关 键 词：寰枕关节 脊柱融合术 吞咽障碍 

分 类 号：R687.3[医药卫生—骨科学]