马骏雄;项良碧;于海龙;陈语;王琪;刘军;

• 1:沈阳军区总医院骨科

摘要(Abstract)：

[目的]比较分析低位和高位颈椎前路融合术后椎前软组织肿胀程度和吞咽困难发生率。[方法]研究共纳入行颈椎前路融合术的颈椎病患者123例,其中低位组(C5以下)51例,高位组72例(C5以上,包括C4、5),根据侧位X线测量计算椎前软组织肿胀宽度,比较分析术后椎前软组织肿胀程度及吞咽困难发生率。同时,根据手术节段长短将样本分为单节段融合组(n=50)和双节段融合组(n=48),再进行组内低位和高位组间的比较分析,以消除手术节段长短对分析结果的影响。[结果]低位组术后椎前软组织肿胀宽度为(8.63±4.44)mm,吞咽困难发生率为41.2%,均低于高位组的(12.10±4.77)mm和63.9%(P<0.05)。对于单节段融合手术,低位组术后椎前软组织肿胀宽度为(8.37±4.22)mm,吞咽困难发生率为36.1%,均低于高位组的(9.63±3.44)mm和50.0%(P<0.05)。对于双节段融合手术,低位组术后椎前软组织肿胀宽度为(9.27±4.96)mm,吞咽困难发生率为53.3%,均低于高位组的(13.24±4.75)mm和75.8%(P<0.05)。[结论]高位颈椎手术可能是颈椎前路术后椎前软组织肿胀和吞咽困难发生的危险因素之一,术前针对相关患者进行宣教具有一定的必要性和临床意义。

关键词(KeyWords)： 颈椎;前路;椎前软组织肿胀;高位;低位

Abstract:

Keywords:

基金项目(Foundation): 辽宁省科技攻关课题资助(编号:2011225041)

作者(Author): 马骏雄;项良碧;于海龙;陈语;王琪;刘军;

Email:

DOI:

参考文献(References)：

• [1]Mendoza Lattes S,Clifford K,Bartelt R,et al.Dysphagia following anterior cervical arthrodesis is associated with continuous,strong retraction of the esophagus[J].J Bone Joint Surg Am,2008,2:256-263.
• [2]Riley LH III,Vaccaro AR,Dettori JR,et al.Postoperative dysphagia in anterior cervical spine surgery[J].Spine,2010,35:76-85.
• [3]Mendoza-Lattes S,Clifford K,Bartelt R,et al.Dysphagia following anterior cervical arthrodesis is associated with continuous strong retraction of the esophagus[J].J Bone Joint Surg Am,2008,90:256-263.
• [4]王乐,刘少喻,梁春祥,等.颈椎前路内固定手术并发症分析[J].中国矫形外科杂志,2012,24:2255-2259.
• [5]Frempong-Boadu A,Houten JK,Osborn B,et al.Swallowing and speech dysfunction in patients undergoing anterior cervical discectomy and fusion:a prospective,objective preoperative and postoperative assessment[J].J Spinal Disord Tech,2002,5:362-368.
• [6]Martin RE,Neary MA,Diamant NE.Dysphagia following anterior cervical spine surgery[J].Dysphagia,1997,1:2-8.
• [7]Winslow CP,Winslow TJ,Wax MK.Dysphonia and dysphagia following the anterior approach to the cervical spine[J].Arch Otolaryngol Head Neck Surg,2001,1:51-55.
• [8]Riley LH 3rd,Skolasky RL,Albert TJ,et al.Dysphagia after anterior cervical decompression and fusion:prevalence and risk factors from a longitudinal cohort study[J].Spine(Phila Pa 1976),2005,22:2564-2569.
• [9]Fogel GR,McDonnell MF.Surgical treatment of dysphagia after anterior cervical interbody fusion[J].Spine J,2005,2:140-144.
• [10]Seidl RO,Todt I,Ernst A.Esophagus atresia aft er cervical spine surgery:case report and literature review[J].Eur Arch Otorhinolaryngol,2007,3:291-293.
• [11]Suk KS,Kim KT,Lee SH,et al.Prevertebral soft tissue swelling after anterior cervical discectomy and fusion with plate fixation[J].Int Orthop,2006,4:290-294.
• [12]Sanfi lippo JA Jr,Lim MR,Jacoby SM,et al.“Normal”prevertebral soft tissue swelling following elective anterior cervical decompression and fusion[J].J Spinal Disord Tech,2006,6:399-401.
• [13]Suk KS,Kim KT,Lee JH,et al.Prevertebral soft tissue swelling after anterior cervical discectomy and fusion:comparison between plate fixation and cage insertion[J].J Korean Orthop Assoc,2009,2:249-255.