颈椎前路融合术后吞咽困难危险因素的研究进展

颈椎前路减压椎间融合术被广泛用于治疗颈椎间盘退变性疾病,吞咽困难为其术后常见的并发症,主要表现为吞咽食物过程中出现功能障碍及吞咽时产生咽部、胸骨后或食管部位的梗阻、停滞、烧灼等不适感,影响患者预后.本文通过回顾近年来国内外文献,对颈椎前路融合术后吞咽困难的危险因素进行综述.     

颈椎前路手术并发症研究进展

颈椎前路手术已成为颈椎手术中的一种常用手术入路,虽然它被公认为相对安全和有效,但因手术所造成的并发症仍是术者和患者不小的挑战。了解这些并发症种类和处理方法有重要意义。本文综述了颈椎前路手术并发症的种类及相关预防和治疗措施。     

老年颈椎前路手术患者术后发生心肺并发症危险因素及其预测模型的构建

目的 探讨颈椎前路手术老年患者术后发生心肺并发症的危险因素并构建及验证相关列线图(Nomogram)模型。方法 回顾性收集2014年1月至2020年12月于萍乡市第二人民医院接受颈椎前路手术老年患者的病历资料,对其术后是否发生心肺并发症分为观察组(n=77)与对照组(n=390)。比较两组术前的病历资料,受试者工作特征(ROC)曲线确定影响颈椎前路手术老年患者术后心肺并发症高风险因素的最佳截断值,多因素Logistic回归分析确定独立危险因素,R软件“rms”包构建Nomogram模型,校正曲线及决策曲线分析对Nomogram模型进行准确度与区分度的验证。结果 年龄(≥74岁)、美国麻醉医师协会(ASA)分级(Ⅲ～Ⅳ级)、1 s用力呼气容积占预计值百分比(FEV1%,≤60%)、左心室射血分数(LVEF,≤50%)、麻醉时间(≥110 min)、术中失血量(≥200 ml)是颈椎前路手术老年患者术后心肺并发症高风险的独立危险因素(P<0.05)。基于上述独立危险因素构建Nomogram预测模型,校正曲线提示模型准确度良好;决策曲线显示,此Nomogram模型可提供显著高于单个独立...     

颈椎前路术后护理

近年来,颈椎前路手术在骨科应用并得到普及。因为颈椎前路手术解剖复杂,相关许多重要的器官组织,患者大多是颈椎疾病或颈椎外伤,手术中和术后往往会出现并发症。为避免并发症发生,围手术期的护理显得尤为重要,现将我院骨科开展颈椎前路减压、自体髂骨植骨融合术后护理报道如下。     

有限性选择性颈椎前路减压融合术治疗老年多节段颈椎病

颈椎病作为一种退变性疾病,随着人均寿命的延长,在老年病人中发病率逐渐增高。老年人颈椎病往往表现出起病隐匿,就医晚,症状重,多节段受累的特点,而且老年病人合并慢性内科疾病的比例非常高,故老年人颈椎病的手术治疗有其独特的规律[1]。现回顾分析本中心有限性选择性颈椎前路减压融合手术治疗老年人多节段颈椎病17例的治疗情况。1资料与方法1.1病例资料1.1.1一般情况：     

颈椎前路减压植骨内固定术治疗老年脊髓型颈椎病的疗效

<正>脊髓型颈椎病(CSM)是颈椎退变引起脊髓受压和(或)脊髓供血障碍所导致的脊髓功能障碍性疾病,约占颈椎病总数的10%~15%,是各型颈椎病中的最严重的类型,也是55岁以上人群中脊髓功能障碍的最常见原因〔1〕。脊髓型颈椎病发病率随着年龄的增长逐渐升高。老年患者具有病程长、病情重、并发症多的特点,治疗起来颇为棘手。本文回顾性分析行颈椎前路手术的老年脊髓型颈椎病患者的手术疗效。     

颈椎前路手术治疗外伤性高位截瘫103例护理体会

自1999年5月以来，我院采用颈椎前路减压植骨、钢板内固定术治疗颈椎外伤骨折并截瘫患者103例，取得良好疗效，现将护理体会报告如下。     

后路手术治疗颈椎管狭窄合并颈椎间盘突出56例临床分析

1996年 2月～ 2 0 0 1年 2月 ,我们手术治疗颈椎管狭窄合并颈椎间盘突出 56例 ,效果满意。现报告如下。一般资料 :本组男 30例 ,女 2 6例 ,年龄 39～ 74岁 ,平均52岁。病程 6个月～ 6年 ,平均 2 5年。按日本骨科学会(ＪＯＡ)颈椎病疗效评定标准 ,术前术后分别给患者评分。病情     

颈椎前路手术中应用AO锁定型颈椎前路钢板13例临床效果分析

颈椎前路带锁钢板可为植骨提供有效固定,植骨融合率明显提高。1998～2001年,我们在颈椎前路手术中应用AO锁定型颈椎前路钢板13例,效果满意。现报告如下。临床资料：本组13例,男11例,女2例;年龄30～67岁,平均51．6岁。脊髓型颈椎病7例,颈椎椎体骨折、脱位伴截瘫6例（Frankel A级2例,B级1例,C级3例）。单节段融合7例,双节段融合6例。最高节段为C3,最低节段C7。均采用AO锁定型颈前路钢板行内固定术。     

Risk factors associated with dysphagia after anterior surgery in treatment for multilevel cervical disorder with kyphosis

This is a retrospective study. Our aim was to investigate the risk factors related to dysphagia following anterior surgery treating the multilevel cervical disorder with kyphosis based on a subgroup of follow-up time. Finally, a total of 81 patients suffering from the multilevel cervical disorder with kyphosis following anterior surgery from July 2018 to June 2020 were included in our study. Patients with dysphagia were defined as the dysphagia group and without dysphagia as the no-dysphagia (NG) group based on a subgroup of follow-up time (1-week, 1-month, 3-month, 6-month, and 1-year after surgery). Clinical outcomes and radiological data were performed to compare between dysphagia group and NG. In our study, the rate of dysphagia was 67.9%, 44.4%, 34.6%, 25.9%, and 14.8% at 1-week, 1-month, 3-month, 6-month, and 1-year after surgery, respectively. Our findings showed that change of Cobb angle of C2–7 was associated with dysphagia within 3-month after surgery. Furthermore, postoperative Cobb angle of C2–7 was linked to dysphagia within 6-month after surgery. Interestingly, a history of smoking and lower preoperative SWAL-QOL score were found to be risk factors related with dysphagia at any follow-up. In the present study, many factors were found to be related to dysphagia within 3-month after surgery. Notably, a history of smoking and lower preoperative SWAL-QOL score were associated with dysphagia at any follow-up. We hope this article can provide a reference for spinal surgeons to predict which patients were susceptible to suffering from dysphagia after anterior surgery in the treatment of multilevel cervical disorder with kyphosis.     

Anterior cervical transpedicular screw fixation system in subaxial cervical spine: A finite element comparative study

Multilevel cervical corpectomy has raised the concern among surgeons that reconstruction with the anterior cervical screw plate system (ACSPS) alone may fail eventually. As an alternative, the anterior cervical transpedicular screw (ACTPS) has been adopted in clinical practice. We used the finite element analysis to investigate whether ACTPS is a more reasonable choice, in comparison with ACSPS, after a 2-level corpectomy in the subaxial cervical spine. These 2 types of implantation models with the applied 75 N axial pressure and 1 N • m pure moment of the couple were evaluated. Compared with the intact model, the range of motion (ROM) at the operative segments (C4–C7) decreased by 97.5% in flexion-extension, 91.3% in axial rotation, and 99.3% in lateral bending in the ACTPS model, whereas it decreased by 95.1%, 73.4%, 96.9% in the ACSPS model respectively. The ROM at the adjacent segment (C3/4) in the ACTPS model decreased in all motions, while that of the ACSPS model increased in axial rotation and flexion-extension compared with the intact model. Compared to the ACSPS model, whose stress concentrated on the interface between the screws and the titanium plate, the stress of the ACTPS model was well-distributed. There was also a significant difference between the maximum stress value of the 2 models. ACTPS and ACSPS are biomechanically favorable. The stability in reducing ROM of ACTPS may be better and the risk of failure for internal fixator is relatively low compared with ACSPS fixation except for under lateral bending in reconstruction the stability of the subaxial cervical spine after 2-level corpectomy.     

Preoperative esophageal manometry does not predict postoperative dysphagia following anti-reflux surgery

This prospective study was undertaken to determine the value of manometric studies in predicting postoperative dysphagia in patients undergoing laparoscopic Toupet fundoplication. Two hundred and twenty-nine out of 401 patients (57%) had preoperative dysphagia, and 26 patients had late postoperative dysphagia (6.5%). Eight patients who had no preoperative dysphagia developed dysphagia following surgery. There were no significant differences in esophageal motility for patients without postoperative dysphagia (n = 375) compared with those with postoperative dysphagia (n = 26). Among patients with postoperative dysphagia as a new symptom (n = 8), six had normal preoperative distal esophageal pressures, and none had esophageal hypomotility. In those with both pre- and postoperative dysphagia 15 of 18 had normal esophageal motility and hypomotility was only found in one. The positive predictive values of distal esophageal hypomotility and other measures for postoperative dysphagia are poor. In conclusion, preoperative manometry does not predict postoperative dysphagia following laparoscopic Toupet partial fundoplication.     

Relationship of cervical spine disorders to dysphagia

Extrinsic esophageal compression by cervical osteophytes as a cause of dysphagia was first reported by Zahn in 1905. Yet, despite the high incidence of osteophytes of the cervical spine, dysphagia secondary to degenerative disease of the cervical spine is very uncommon. In a review of 116 cases of degenerative arthritis of the cervical spine requiring therapy, dysphagia was documented in only 7 (Saffouri and Ward 1974). In a review of 1,200 patients with dysphagia, none demonstrated dysphagia due to cervical spine disease (Leroux 1962). The attribution of dysphagia to a cervical spine abnormality should therefore be made with extreme caution. Objective evidence of impairment of pharyngeal function by the cervical abnormality should always be sought. Critical evaluation of dynamic studies of swallow by motion recording radiographic techniques can provide such evidence. This report presents our findings in a series of patients with cervical spine disorders evaluated in the Johns Hopkins Swallowing Center over a 2 year period.     

Clinical presentation of patients with acute cervical spine injury

A retrospective review of 67 patients with acute cervical spine fracture and/or dislocation was conducted at two suburban community hospital emergency departments. The mean age was 39, and two-thirds of the patients were male. Motor vehicle accidents and falls accounted for more than 80% of all injuries. On emergency department evaluation, it was found that there was no history of loss of consciousness in 42 patients (63%), no associated cranio-facial injuries in 31 patients (46%), and a normal sensorimotor examination in 59 patients (88%). Thirty-four patients (50%) were evaluated for cervical range of motion, which was found to be normal in one-third of the cases. The absence of mental status changes, cranio-facial injuries, range of motion abnormalities, and focal neurological findings is, therefore, not uncommon in patients who have sustained cervical spine injury.     

Neurologic complications following immobilization of cervical spine fracture in a patient with ankylosing spondylitis

Axial traction is widely recommended for stabilization of cervical spine fractures. This procedure may be inappropriate and even dangerous in patients with long-standing ankylosing spondylitis (AS). We present the case of an 80-year-old woman with AS who fell at home and suffered an unstable large C5-C6 fracture/dislocation associated with left-sided weakness and decreased sensation. Medical treatment included placing her neck in a neutral position, despite her preference for neck flexion. This procedure increased her pain and paresthesias; the complications decreased, but did not entirely resolve, when the patient resumed a semi-flexed position. This patient's neurologic sequelae may have been exacerbated by attempts to stabilize her neck in a neutral position. Standard stabilization recommendations should be appropriately altered in some patients with cervical spine AS.