颈前路多节段融合术后吞咽困难的原因分析

目的 比较多节段颈前路椎间盘切除减压融合术中采用传统钢板+cage和“零切迹”颈椎椎间融合器植入患者术后吞咽困难的发生情况,并分析其原因.方法 2008年9月至2011年9月,接受颈前路椎间盘切除减压+前路钢板+cage植入的118例多节段颈椎病患者为钢板cage组,接受颈前路椎间盘切除减压+Zero-p颈椎椎间融合器植入的108例患者为Zero-p组.分别于术前、术后第2天、术后3、6、12个月及末次随访时采用日本矫形外科学会评分法(Japan orthopedic association,JOA)对患者的神经功能情况进行评估；摄颈椎X片评价植骨融合程度、内固定相关并发症及椎前软组织肿胀程度；采用Bazaz吞咽困难分级及改良吞咽生活质量量表(swallowing-quality of life,SWAL-QOL)评估患者吞咽困难的发生率及相关症状发生情况.结果 随访时间平均为2.4年(1.0～3.5年).术后第2天钢板cage组发生吞咽困难49例(41.53％)明显高于Zero-p组(36例,33.33％)；钢板cage组术后第2天及术后2个月椎前软组织厚度明显大于Zero-p组.术后第2天Zero-p组中手术范围为C3～C6的患者吞咽困难发生率(43.1％)明显高于手术范围为C4～C7的患者(22％).结论 颈前路多节段融合术后吞咽困难不可避免,内固定的选择和手术范围是术后吞咽困难发生的重要影响因素.使用颈椎“零切迹”植入物可以减少术后吞咽困难的发生率,手术节段越高术后吞咽困难的发生率越高.

Analysis on the causes of dysphagia after multilevel anterior cervical discectomy and fusion

Objective To investigate incidence and related factors of dysphagia after fusion with an anterior cervical plate plus cage or a stand-alone cage (Zero-p cage) following anterior cervical discectomy procedure for treating multilevel cervical spondylotic myelopathy (MCSM). Methods From September 2008 to September 2011, 226 patients with MCSM underwent anterior cervical discectomy and fusion using an anterior cervical plate plus cage (118 patients, P&C group) or a stand-alone cage (108 patients, Zero-p group). Neurological function was evaluated by Japan orthopedic association (JOA) scores before and after operation. Cervical X-rays were taken to assess the graft fusion, internal fixation related complications and the thickness of the prevertebral soft tissue. The Bazaz dysphagia score and Swallowing Quality of Life questionnaire were used to assess the incidence and degree of dysphagia. Results The average follow-up time was 2.4 years (range, 1.0 to 3.5 years). The incidence of dysphagia was 41.53% in P&C group, while 33.33% in Zero-p group at 2 days after operation. The thickness of the prevertebral soft tissue in P&C group was significantly thicker than that in Zero-p group at 2 days and 2 months after surgery. In Zero-p group, the incidence of dysphagia was 43.1% in patients who underwent operation from C₃ to C₆, while 22% in patients who underwent operation from C₄ to C₇. Conclusion Dysphagia is common after multilevel anterior cervical discectomy and fusion. The choice of implants and the extent of operation are important influencing factors of postoperative dysphagia. The use of stand-alone cage can decrease the incidence of dysphagia. The operation at higher levels has a higher incidence of dysphagia.