中国组织工程研究

中国组织工程研究 ›› 2018, Vol. 22 ›› Issue (7): 1026-1031.doi: 10.3969/j.issn.2095-4344.0112

• 脊柱植入物 spinal implant • 上一篇    下一篇

单节段颈前路减压椎间融合治疗后发生吞咽困难的相关因素

陆英杰，鲍卫国，邹 俊，周 峰，姜为民，杨惠林，张志明，朱雪松   

  1. 苏州大学附属第一医院骨科，江苏省苏州市 215006
  • 出版日期:2018-03-08 发布日期:2018-03-08
  • 通讯作者: 张志明，博士，副主任医师，苏州大学附属第一医院骨科，江苏省苏州市 215006 朱雪松，博士，研究员，苏州大学附属第一医院骨科，江苏省苏州市 215006
  • 作者简介:陆英杰，男，1992年生，江苏省昆山市人，汉族，苏州大学在读硕士，主要从事脊柱外科、组织工程方面的研究。
  • 基金资助:

    国家自然科学基金(81772358)；国家高技术研究发展计划(863计划)(2015AA020316)

Related factors for dysphagia after single-level anterior cervical descectomy and fusion

Lu Ying-jie, Bao Wei-guo, Zou Jun, Zhou Feng, Jiang Wei-min, Yang Hui-lin, Zhang Zhi-ming, Zhu Xue-song   

  1. Department of Orthopedics, First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
  • Online:2018-03-08 Published:2018-03-08
  • Contact: Zhang Zhi-ming, M.D., Associate chief physician, Department of Orthopedics, First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China Zhu Xue-song, M.D., Researcher, Department of Orthopedics, First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
  • About author:Lu Ying-jie, Studying for master’s degree, Department of Orthopedics, First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
  • Supported by:

    the National Natural Science Foundation of China, No. 81772358; the National High Technology Research and Development Program of China (863 Program), No. 2015AA020316

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摘要：

文章快速阅读：

 

文题释义：
吞咽困难：是指发生在口腔和胃之间的吞咽功能障碍的一种症状。根据发生部位可分为口咽性吞咽困难和食管性吞咽困难。口咽性吞咽困难是指进食后无法顺利形成食团或食团形成后难以进入食管而引起的一种吞咽功能障碍的症状，表现为哽咽感、呛咳、误吸(食物、分泌物或液体从口咽部进入气管或肺部)和窒息；食管性吞咽困难则是指食物在食管运输减慢、部分或完全梗阻，表现为反流、胸骨后黏滞感和体质量减轻的症状。
后纵韧带骨化：颈椎后纵韧带骨化是一种原因未明的病理现象, 表现为颈椎后纵韧带内异位骨形成。其发生发展一般较为缓慢，患者早期可不出现任何临床症状，但当骨化块增厚增宽到一定程度，引起颈椎椎管狭窄，压迫脊髓、神经根或血管时称为颈椎后纵韧带骨化症。临床表现为肢体的感觉和运动障碍，以及内脏自主神经功能紊乱的症状。
 
摘要
背景：颈前路减压椎间融合术后患者有很高的吞咽困难发生率，其发病原因可能与多种因素有关，具体发生机制仍不清楚。
目的：研究单节段颈前路减压椎间融合术后吞咽困难的相关因素。
方法：回顾性分析苏州大学附属第一医院2011年1月至2015年1月因颈椎间盘退行性疾病接受单节段颈前路椎间融合术的病例，住院期间记录患者的基本信息以及手术相关资料，包括手术时间、术中失血量、手术节段、内固定装置以及有无使用重组人骨形态发生蛋白2等。术前和术后第3天测量颈椎曲度以及各节段椎前软组织肿胀程度。术后1，3，6，12，24个月用Bazaz吞咽功能评分系统分别对患者的吞咽情况进行评估。
结果与结论：纳入接受单节段颈前路椎间融合术的患者262例，术后1，3，6，12，24个月吞咽困难发生率分别为35.9%，22.9%，15.6%，11.5%，9.2%。单因素分析结果显示性别、手术时间以及病程长短与术后吞咽困难发生相关。Logistic多因素回归分析结果显示手术时间(≥3 h)、女性和病程长短(≥8个月)为单节段颈前路椎间融合术后吞咽困难的危险因素。其中手术时间和女性可能与术后早中期吞咽困难相关，而病程可能与术后慢性吞咽困难相关。椎前软组织肿胀厚度等其他因素与单节段颈前路减压椎间融合术后吞咽困难没有相关性。对于多节段融合术后吞咽困难的风险因素还应进一步研究。

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程
ORCID: 0000-0003-4964-5574(朱雪松)

关键词: 吞咽困难, 风险因素, 颈前路, 融合, 颈椎病, 脊柱, 退行性病变, 单节段, 术后并发症, 骨科植入物, 脊柱植入物, 国家自然科学基金

Abstract:

BACKGROUND: Patients with anterior cervical discectomy and fusion have a high incidence of dysphagia, which may be associated with a variety of factors. The specific mechanism remains unclear.

OBJECTIVE: To explore the related factors of dysphagia after single-level anterior cervical discectomy and fusion.
METHODS: We retrospectively analyzed patients with cervical degenerative disc disease receiving single-level anterior cervical discectomy and fusion in First Affiliated Hospital of Soochow University from January 2011 to January 2015. During hospitalization, basic patient data and surgery-related data were recorded, including operation time, intraoperative blood loss, surgical segment, internal fixation device and the use of recombinant human bone morphogenetic protein-2. The cervical alignment and prevertebral soft tissue swelling were measured preoperatively and 3 days postoperatively. At 1, 3, 6, 12, and 24 months postoperatively, the Bazaz swallowing function scoring system was used to assess the swallowing of the patients.
RESULTS AND CONCLUSION: A total of 262 patients undergoing single-level anterior cervical discectomy and fusion were involved. The incidence of dysphagia at 1, 3, 6, 12, and 24 months postoperatively was 35.9%, 22.9%, 15.6%, 11.5% and 9.2% respectively. Univariate analysis showed that gender, operation time and course length were associated with postoperative dysphagia. Logistic multivariate regression analysis showed that the duration of operation (≥ 3 hours), female and course length (≥ 8 months) were risk factors for dysphagia after anterior cervical descectomy and fusion. Operation time and female may be associated with early and middle dysphagia postoperatively, and the course length may be associated with chronic dysphagia. Prevertebral soft tissue swelling and other factors are not related to dysphagia after single-level anterior cervical discectomy and fusion. Risk factors for dysphagia after multi-level fusion should be further studied.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Cervical Vertebrae, Spinal Fusion, Postoperative Complications, Dysphagia, Tissue Engineering

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