颈前路减压Zero-P融合固定术后吞咽困难的影响因素

The related factors of dysphagia after anterior cervical discectomy and fusion with the Zero-profile implant system

中文关键词:  颈椎病  前路减压融合术  Zero-P  吞咽困难  影响因素

英文关键词:Cervical spondylosis  Anterior cervical discectomy and fusion  Zero-P  Dysphagia  Related factors

中文摘要:

  【摘要】 目的：分析颈前路减压Zero-P融合固定术后吞咽困难的影响因素。方法：对2011年1月～2016年12月行颈前路减压Zero-P融合固定术且至少1年以上的115例患者的资料进行回顾性分析。其中男66例，女49例。采用电话或门诊随访的方式，以Bazaz评分系统评估术后3d吞咽困难程度，根据是否存在术后吞咽困难将所有患者分为吞咽困难组（轻、中、重度吞咽困难患者）和无吞咽困难组，分析性别、年龄、身体质量指数（body mass index，BMI）、糖尿病、高血压、吸烟、饮酒、手术时间、术中出血量、术后椎前软组织肿胀程度（术后软组织厚度与术前软组织厚度的差值）、术后O-C2角度、术后C2-7角度、手术最高节段、手术节段数等因素与术后吞咽困难发生的相关性，并重点探讨术后C2-7角度这一因素。两组间定量变量的差异采用独立样本t检验的方法进行比较，定性变量差异进行卡方检验。为排除混杂因素影响，将单因素分析中P＜0.2的因素纳入二元Logistic回归模型进行多因素汇总分析。采用Spearman秩相关检验验证术后C2-7角度与吞咽困难严重程度的相关性。结果：吞咽困难组18例，男11例，女7例；无吞咽困难组97例，男55例，女42例。单因素分析结果显示，年龄、术后O-C2角度、术后C2-7角度及椎前软组织肿胀程度两组间比较均有统计学差异（P＜0.05），性别、BMI、糖尿病、高血压、吸烟、饮酒、手术时间、术中出血量、手术最高节段、手术节段数两组间比较均无统计学差异（P＞0.05）。单因素分析中P＜0.2的因素包括年龄、BMI、术中出血量、术后O-C2角度、术后C2-7角度及术后椎前软组织肿胀。将单因素分析中P＜0.2的因素纳入Logistic回归分析，术后C2-7角度及椎前软组织肿胀与术后发生吞咽困难呈显著相关（P＜0.05），年龄、BMI、术中出血量和术后O-C2角度与术后吞咽困难的发生均无显著相关性（P＞0.05）。吞咽困难组术后C2-7角度为9.17°～36.39°（19.14°±6.73°），无吞咽困难组为1.59°～20.45°（10.88°±5.36°），吞咽困难组术后C2-7角显著大于无吞咽困难组（P＜0.05）。将C2-7角≥12°时的吞咽困难发生率（26.2％，16/61）和C2-7角＜12°时吞咽困难的发生率（3.7％，2/54）进行比较，差异有统计学意义（P＜0.05）。将18例吞咽困难患者（轻度16例，重度2例）的术后C2-7角度与吞咽困难等级进行Spearman秩相关分析，结果显示两者不存在显著相关性（P＞0.05）。结论：颈前路减压Zero-P融合固定术后C2-7角度及椎前软组织肿胀对患者术后吞咽困难的发生有重要的影响，术中注意C2-7角度的调整及控制术后的椎前软组织肿胀可降低患者术后发生吞咽困难的风险。

英文摘要:

  【Abstract】 Objectives: To investigate the related factors of dysphagia after anterior cervical discectomy and fusion with the zero-profile implant system. Methods: A retrospective analysis of 115 patients who had undergone Zero-P implant system interbody fusion surgery and followed up for at least one year was performed from January 2011 to December 2016, including 66 males and 49 females. The Bazaz scoring system was used to assess the degree of dysphagia by telephone or outpatient follow-up. All patients were divided into non-dysphagia group and dysphagia group (light, moderate, and severe dysphagia patients) according to the presence or absence of postoperative dysphagia to explore the effect of the age, gender, body mass index(BMI), diabetes mellitus, hypertension, smoking, alcohol consumption, intraoperative time, estimated blood loss, prevertebral soft-tissue swelling, postoperative O-C2 angle, postoperative C2-7 angle, the highest segment of surgery and the number of surgical segments. At the same time, the effect of postoperative C2-7 angle was mainly discussed. The student t-test and a chi-squared test were conducted for continuous and categorical data, respectively. The Spearman′s correlation coefficient was conducted between the degree of dysphagia and postoperative C2-7 angle. To eliminate the influence of confounding factors, ordinal logistic regression was performed for multifactor regression of factors which had a P value less than 0.2 in the single factor analysis. Results: There were 18 patients(11 males and 7 females) in the dysphagia group; 97 patients(55 males and 42 females) in the non-dysphagia group. Significant correlation was showed with the comparison of age, postoperative C2-7 angle, postoperative O-C2 angle and prevertebral soft-tissue swelling between two groups(P<0.05). There was no significant correlation between age, BMI, estimated blood loss and postoperative dysphagia(P>0.05). The factors with P value less than 0.2 in the single factor analysis included age, BMI, estimated blood loss, postoperative O-C2 angle, postoperative C2-7 angle and prevertebral soft-tissue swelling. Logistic regression analysis showed that the postoperative C2-7 angle and prevertebral soft-tissue swelling were significantly associated with postoperative dysphagia(P<0.05). In the dysphagia group, the C2-7 angle was 9.17°-36.39°, with an average of 19.14°±6.73°. In the asymptomatic group, the C2-7 angle was 1.59°-20.45°, with an average of 10.88°±5.36°. The average postoperative C2-7 angle was significantly greater in the patients with dysphagia than in the non-dysphagia group(P<0.05). Compared the incidence of dysphagia(3.7%, 2/54) when C2-7 angle<12° with the incidence of dysphagia when C2-7 angle≥12°(26.2%, 16/61), the difference was statistically significant(P<0.05). Spearman′s correlation coefficient of the dysphagia group(18 patients, mild: 16; moderate: 0; severe: 2) between degree of dysphagia and incidence of postoperative dysphagia showed no significant correlation. Conclusions: The postoperative C2-7 angle and prevertebral soft-tissue swelling has an important effect on the occurrence of dysphagia in patients undergoing anterior cervical discectomy and fusion with the zero-profile implant system. Paying attention to the adjustment of the C2-7 angle during surgery and the control of prevertebral soft-tissue swelling may reduce the incidence of postoperative dysphagia.