颈椎前路术后吞咽困难的相关因素分析

Related factors to dysphagia after anterior cervical spine surgery

中文关键词:  吞咽困难  颈椎  颈椎前路手术  相关因素

英文关键词:Dysphagia  Cervical spine  Anterior cervical spine surgery  Related factors

中文摘要:

  【摘要】 目的：探讨颈椎前路手术后发生吞咽困难的相关因素。方法：随访2008年8月～2010年7月收治的颈椎前路手术患者135例，其中男82例，女53例；年龄32～80岁，平均58.2岁；诊断为脊髓型颈椎病58例，神经根型颈椎病32例，混合型颈椎病18例，后纵韧带骨化症27例。入院后均由同一组医师治疗，手术方式分为颈椎前路减压融合术（ACDF）、颈椎前路次全切减压融合术（ACCF）和人工颈椎间盘置换术（TDR）。观察患者手术后是否存在吞咽困难：对于存在吞咽困难的患者均静脉应用甲泼尼松龙及对症治疗。结果：术后共有36例（26.7％）患者出现吞咽困难，男11例，女25例，年龄42～80岁，平均59．6岁；其余99例，年龄32~76岁，平均52．3岁，发生吞咽困难者平均年龄显著高于未发生者（P<0．05）。发生吞咽困难患者中使用钛板内固定35例，其中单节段2例（9.1％），双节段13例（21.0％），多节段（包括三节段及三节段以上者）20例（52.6％）；颈椎人工椎间盘置换者1例；术后吞咽困难发生率使用内固定者较人工椎间盘置换者高（P＜0.05），多节段内固定者较单、双节段者明显升高（P＜0.05）。手术最高节段累及C2或C3者23例，术后吞咽困难发生率26.1%；累及C4或C5者88例，发生率28.4%；累及C6或C7者24例，发生率20.1%，三组两两比较无统计学差异（P>0.05）。吞咽困难者的手术时间、失血量及住院天数与未发生吞咽困难者比较均无统计学差异（P＞0.05）。35例（97．2％）患者的吞咽困难症状在术后6个月内减轻或消失，1例至随访1年时症状才消失。结论：女性、高龄、使用钛板内置物、手术节段多可能是颈椎前路手术后发生吞咽困难的相关因素，临床医生应给予相应重视和采取相应措施以减少其发生。

英文摘要:

  【Abstract】 Objectives: To evaluate the related factors of dysphagia following anterior cervical spine surgery．Methods: 135 cases undergoing anterior cervical spine surgery from August 2008 to July 2010 were followed up. There were 82 males and 53 fema1es, with a mean age of 58.2 years(range，32 to 80 years)． Of these 135 patients, 58 had cervical spondylotic myelopathy(CSM), 32 had cervical radiculopathy, 18 had cervical myeloradiculopathy, 27 had ossification posterior longitudinal ligament(OPLL). All cases were treated by the same surgical group including anterior cervical discectomy and fusion(ACDF), and/or anterior cervical compectomy and fusion(ACCF), and total disc replacement(TDR). 135 patients were reviewed retrospectively on their postoperative dysphagia. All cases with dysphgia accepted Methylprednisolone intravenously and correspondant therapy． Results: 135 cases were followed up, and 36(26.7％) of them had postoperative dysphagia, including 11 males and 25 females． The age of patients with dysphagia ranged from 42 to 80 years, average age was 59.6. The rest age ranged from 32 to 76, the average age was 52.3, which was more significant compared to the former(P<0.05). 35 cases with postoperative dysphagia had titanium plates placement, while 1 case with cervical artificial disc replacement had dysphagia. The rate of dysphagia in multi-level group was significantly higher than the single-level and two-level group. In the group with surgical level related to C2 and C3, dysphagia rate was 26.1%. In the group with surgical level related to C4 and C5, dysphagia rate was 28.4%. In the group with surgical level related to C6 and C7, dysphagia rate significance between each two groups(P>0.05). There was no statistical significance in the surgical time, blood loss or hospital day(P>0.05). After 6 month follow-up, 35 cases(97.2％) had dysphagia cured or improved． While 1 case had improvement at 1 year follow-up． Conclusions: Female, elder, titanium plating and multiple surgical level numbers may be associated with postoperative dysphagia. As a result, clinicians should pay more attention to this complication and make proper intervention．