單節段和雙/多節段頸椎前路減壓融合術后椎前軟組織腫脹及吞咽困難發生率的比較

·臨床研究·

單節段和雙/多節段頸椎前路減壓融合術后椎前軟組織腫脹及吞咽困難發生率的比較

馬駿雄,陳語,項良碧,于海龍,王琪 ,劉軍

作者單位：110016遼寧，沈陽軍區總醫院骨科

通信作者：劉軍cliffmjx@163.com

【摘要】目的比較分析單節段和雙/多節段頸椎前路融合術后椎前軟組織腫脹程度和吞咽困難發生率。方法納入頸椎前路融合術病例123例，單節段組50例，雙/多節段組73例，在側位X線片上測量椎前軟組織寬度，比較術后椎前軟組織腫脹程度及吞咽困難發生率。結果單節段組術后椎前軟組織腫脹寬度為(8.29±3.98)mm，吞咽困難發生率為40.0%，均低于雙/多節段組的(11.14±5.17)mm和64.4%。且無論高位(C4/C5節段及以上)或低位手術(C5節段以下)，單節段術后椎前軟組織腫脹寬度和吞咽困難發生率均低于雙/多節段術后。結論多節段手術可能是頸椎前路手術術后椎前軟組織腫脹和吞咽困難發生的危險因素之一，術前針對相關人群的宣教具有一定的必要性和臨床意義。

【關鍵詞】頸椎; 脊柱融合術; 減壓術，外科; 手術后并發癥; 軟組織損傷; 吞咽障礙

基金項目：遼寧省科技攻關課題(2011225041)

作者簡介：馬駿雄(1985— )， 博士，主治醫師

【中圖分類號】R 619【文獻標志碼】 A

DOI【】

收稿日期：(2014-03-25)

Comparison of prevertebral soft tissue swelling and dysphagia rate between single-level and double/multiple-level anterior cervical decompression and fusionMAJun-xiong,CHENYu,XIANGLiang-bi,YUHai-long,WANGQi,LIUJun.DepartmentofOrthopaedics,GeneralHospitalofShenyangMilitaryCommand, 110016Shenyang,Liaoning,China

Abstract【】ObjectiveTo investigate the prevertebral soft tissue swelling and dysphagia rate after single-level or double/multiple-level anterior cervical decompression and fusion.Methods A total of 123 patients undering anterior cervical fusion with plate augmentation for cervical spondylosis were included in the study. The patients were divided into single-level group (n=50) and double/multiple-level group (n=73). The postoperative prevertebral soft tissue swelling was measured with lateral roentgenograph. The postoperative prevertebral soft tissue swelling and dysphagia rate were analysed. Meanwhile, to eliminate the impact of operative site on the results, patients were further divided into high-level group (above C5, including C4/C5) and low-level group (below C5). Then the data was compared between single-level group and double/multiple-level group. ResultsPostoperative prevertebral soft tissue swelling and dysphagia rate in single-level group were (8.29 ± 3.98) mm and 40.0%, which were less than that in double/multiple-level group (11.14 ± 5.17) mm and 64.4%. For both high-level operation and low-level operation, postoperative prevertebral soft tissue swelling and dysphagia rate in single-level group were less than those in double/multiple-level group.ConclusionMultiple-level surgery is possibly one of the risk factors of prevertebral soft tissue swelling and dysphagia after anterior cervical surgery. Announcement to relevant patients before the operation might be necessary and clinically meaningful procedure.

【Key words】Cervical vertebrae; Spinal fusion; Decompression, surgical; Postoperative complications; Surgical soft tissue Injuries; Deglutition disorders

J Spinal Surg, 2015,13(1):41-44

頸椎前路椎間盤切除減壓、植骨融合術(anterior cervical discectomy with fusion, ACDF)和頸椎前路椎體次全切除減壓、植骨融合術(anterior cervical corpectomy with fusion, ACCF)是治療頸椎病的經典術式，手術效果好，廣泛應用于臨床。但是，頸椎前路手術后發生的相關并發癥仍不能忽視，如呼吸困難、吞咽困難及喉返神經損傷等。上述并發癥中，吞咽困難的發生率較高[1]，可>50%，嚴重影響患者早期恢復及生活質量。吞……