咽丛神经保护措施在预防长节段颈椎前路固定融合术后吞咽困难中的价值

Clinical efficacy analysis of cervical pharyngeal plexus preservation measures in preventing dysphagia after long-segment anterior cervical discectomy and fusion

中文关键词:  颈椎前路减压固定融合手术  吞咽困难  咽丛神经保护

英文关键词:Anterior cervical discectomy and fusion surgery  Dysphagia  Pharyngeal plexus nerve protection

中文摘要:

  【摘要】 目的：探讨术中采用咽丛神经保护措施在预防长节段颈椎前路固定融合术（anterior cervical discectomy and fusion，ACDF）后吞咽困难中的价值。方法：回顾性分析2018年1月~2024年6月在西藏自治区人民政府驻成都办事处医院行长节段（3～4个节段）ACDF的64例患者，术中采用咽丛神经保护措施的34例患者纳入保护组，术中未采用咽丛神经保护措施的30例患者纳入常规组。两组患者的性别、年龄、病程等一般资料无统计学差异（P>0.05）。记录两组患者的手术节段数量和分布、手术时间及术中出血量等手术相关资料。两组患者术前、术后3个月、术后1年进行颈椎功能障碍指数（neck disability index，NDI）及日本骨科协会（Japanese Orthopaedic Association，JOA）评分，评估手术疗效。术前和术后3d、3个月、1年的SWAL-QOL问卷表以及术后3d、3个月、1年采用Bazaz吞咽困难评估标准评价两组患者术后吞咽困难发生情况及严重程度。术后1年复查CT并采用Brantigan标准评价两组椎间融合情况，其中1~3级为不融合，4、5级为融合。结果：两组患者的手术节段数量和分布、手术时间及术中出血量无统计学差异（P>0.05）。两组患者术后3个月、术后1年NDI及JOA评分均较术前明显改善（P<0.05），两组间术前及术后同随访时间点无统计学差异（P>0.05）。术前两组患者的SWAL-QOL问卷评分无统计学差异（P>0.05）；保护组术后3d评分显著性低于术前（P<0.05），术后3个月、1年评分与术前无统计学差异（P>0.05）；常规组术后3d、3个月、1年评分均显著性低于术前（P<0.05）；术后同随访时间点保护组的SWAL-QOL问卷评分明显低于常规组（P<0.05）。术后3d、3个月、1年保护组出现吞咽困难例数分别为2例、0例、0例，常规组分别为8例、4例、4例，各随访时间点保护组的吞咽困难发生率均低于常规组（P<0.05）。术后1年随访保护组31例融合成功，常规组27例融合成功，两组的融合率（91.2% vs 90.0%）及椎间融合分级无统计学差异（P>0.05）。结论：术中实施咽丛神经保护措施能有效降低长节段颈椎前路固定融合术后吞咽困难的发生率。

英文摘要:

  【Abstract】 Objectives: To explore the value of intraoperative pharyngeal plexus nerve protection in preventing dysphagia following long-segment anterior cervical discectomy and fusion(ACDF). Methods: A retrospective analysis was performed on 64 patients who underwent long-segment(3-4 levels) ACDF in Chengdu Office Hospital of the People′s Government of Xizang Autonomous Region from January 2018 to June 2024. 34 patients received intraoperative pharyngeal plexus nerve protection were assigned to the protection group, and the remaining 30 patients without such protection were included in the conventional group. There were no statistically significant intergroup differences in baseline data including gender, age and disease duration(P>0.05). Operation-related parameters such as number and distribution of operative levels, operative time and intraoperative blood loss were recorded. The neck disability index(NDI) and Japanese Orthopaedic Association(JOA) scores before surgery, at 3 months and 1 year postoperatively were documented to evaluate clinical outcomes. The SWAL-QOL questionnaire was administered preoperatively and at 3d, 3 months and 1 year after surgery. The Bazaz dysphagia grading system was used at 3d, 3 months and 1 year postoperatively to assess the incidence and severity of postoperative dysphagia. Computed tomography(CT) was conducted at the 1-year follow-up. Interbody fusion status was evaluated according to the Brantigan classification, and grades 1-3 were defined as non-fusion, and grades 4-5 as fusion. Results: No statistically significant differences were found between the two groups regarding the number and distribution of operative levels, operative time or intraoperative blood loss(P>0.05). NDI and JOA scores were significantly improved at 3 months and 1 year postoperatively compared with preoperative values in both groups(P<0.05). There were no intergroup differences preoperatively or at same postoperative follow-up time points(P>0.05). Preoperative SWAL-QOL scores were comparable between the two groups(P>0.05). In the protection group, SWAL-QOL scores decreased significantly at postoperative 3d(P<0.05), while scores at 3 months and 1 year showed no significant difference from baseline(P>0.05). In the conventional group, SWAL-QOL scores were markedly lower than preoperative levels at 3d, 3 months and 1 year postoperatively(P<0.05). At each corresponding follow-up time point, SWAL-QOL scores in the protection group were significantly lower than those in the conventional group(P<0.05). At 3d, 3 months and 1 year postoperatively, dysphagia occurred respectively in 2 cases, 0 case, and 0 case in the protection group, while the number was 8, 4, and 4 in the conventional group. The protection group demonstrated a lower dysphagia incidence at all follow-up time points(P<0.05). At the 1-year follow-up, successful interbody fusion was achieved in 31 patients of the protection group and 27 patients of the conventional group. No significant differences were observed in fusion rates(91.2% vs 90.0%) and Brantigan fusion grades between the two groups(P>0.05). Conclusions: Intraoperative pharyngeal plexus nerve protection measures can effectively reduce the incidence of dysphagia after long-segment ACDF.