颈椎前路术后吞咽困难危险因素的Meta分析

Meta-analysis of risk factors for dysphagia after anterior cervical spine surgery

中文关键词:  颈椎前路手术  吞咽困难  危险因素  Meta分析

英文关键词:Anterior cervical spine surgery  Dysphagia  Risk factors  Meta-analysis

中文摘要:

  【摘要】 目的：系统评价颈椎前路术后发生吞咽困难的危险因素，明确独立危险因素，为颈椎前路手术围术期并发症的防治提供指导。方法：检索万方数据库（WanFang）、中国生物医学文献数据库（CBM）、中国知网（CNKI）、维普（VIP）、PubMed、Embase、 Cochrane Library、Web of Science共8个数据库，检索时限从建库至2023年7月15日，搜索关于颈椎前路术后吞咽困难的危险因素的病例对照研究和队列研究，采用纽卡斯尔-渥太华质量评定量表（Newcastle-Ottawa Scale，NOS）对纳入研究进行质量评价和数据提取（包括第一作者、发表年份、研究类型、样本量、评估方式、评估时间及危险因素），通过Stata12软件进行Meta分析。结果：共纳入29篇文献，其中队列研究4篇，病例对照研究25篇，所有文献均为高质量研究，包括颈椎前路术后吞咽困难患者89571 例，对照组3092967例。年龄[优势比（odds ratio，OR）=1.093，95%置信区间（confidential interval，CI）：1.067~1.120]、女性（OR=2.419，95%CI：1.654~3.539）、糖尿病（OR=2.733，95%CI：2.240~3.333）、病程（OR=4.259，95%CI：2.458~7.381）、手术节段数量（OR=1.791，95%CI：1.718~1.868）、手术节段位置（OR=2.332，95%CI：1.812~3.003）、手术时间（OR=1.434，95%CI：1.110~1.852）、钢板内置物（OR=2.188，95%CI：1.413~3.175）及翻修手术（OR=2.687，95%CI：2.316-3.119）与颈椎前路术后发生吞咽困难相关，而吸烟（OR=1.323，95%CI：0.852~2.056）、高血压（OR=1.006，95%CI：0.591~1.713）、体重指数（body mass index，BMI）（OR=1.037，95%CI：0.929~1.159）、颈椎间盘置换（OR=0.577，95%CI：0.085~3.943）、C2-7角度变化（difference between postoperative and preoperative C2-C7 angle，dC2-7）＞5°（OR=1.716，95%CI：0.925~3.183）等因素与其不相关。结论：女性、高龄、术前病程长、合并糖尿病、双节段或多节段手术、高位颈椎手术、手术时间长、使用钢板及翻修手术的患者颈椎前路术后更易发生吞咽困难。

英文摘要:

  【Abstract】 Objectives: To systematically evaluate the risk factors for dysphagia after anterior cervical spine surgery(ACSS), identify the independent risk factors, and to provide a guidance for the prevention and treatment of perioperative complications. Methods: A total of 8 databases including Wanfang, CBM, CNKI, VIP, PubMed, Embase, Cochrane Library, and Web of Science were searched for case-control and cohort studies about the risk factors of dysphagia after ACSS from the establishment of each database to July 15, 2023. Newcastle-Ottawa scale(NOS) was adopted to evaluate the qualities of the included literaure. Related data such as the first author, publication year, research type, sample size, assessment method, evaluation time, and risk factors were extracted and Stata 12 software was used to do the meta-analysis. Results: 29 articles were included, consisting of 4 cohort studies and 25 case control studies. All of the articles were of high quality. The total sample size of patients with dysphagia after ACSS was 89571 and the number of patients in the control group was 3092967. Age(OR=1.093, 95%CI: 1.067-1.120), female(OR=2.419, 95%CI: 1.654-3.539), diabetes mellitus(OR=2.733, 95%CI: 2.240-3.333), disease duration(OR=4.259, 95%CI: 2.458-7.381), levels of surgery(OR=1.791, 95%CI: 1.718-1.868), operative level(OR=2.332, 95%CI: 1.812-3.003), operative time(OR=1.434, 95%CI: 1.110-1.852), plate(OR=2.188, 95%CI: 1.413-3.175) and revision surgery(OR=2.687, 95%CI: 2.316-3.119) were related to dysphagia after ACSS, while smoking(OR=1.323, 95%CI: 0.852-2.056), hypertension(OR=1.006, 95%CI: 0.591-1.713), body mass index(BMI) (OR=1.037, 95%CI: 0.929-1.159), cervical disc arthroplasty(OR=0.577, 95%CI: 0.085-3.943) and difference between postoperative and preoperative C2-7 angles(dC2-7)＞5°(OR=1.716, 95%CI: 0.925-3.183) were not. Conclusions: Patients who are female, old aged, with long preoperative disease duration and diabetes mellitus, undergoing double or multi-level surgery, upper cervical spine surgery, and revision surgery, prolonged operation time, and use of plate, are prone to have dysphagia after ACSS.