Apfelbaum R I, Kriskovich M D, Haller J R
Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah 84132, USA.
Spine (Phila Pa 1976). 2000 Nov 15;25(22):2906-12. doi: 10.1097/00007632-200011150-00012.
A retrospective review of contemporaneously acquired clinical data supplemented by experimental cadaver dissection.
To establish the incidence and mechanism of vocal cord paralysis after anterior cervical spine surgery and to determine whether controlling for endotracheal tube (ET)-laryngeal wall interactions induced by the cervical retraction system could decrease the rate of paralysis.
Vocal cord paralysis is the most common otolaryngologic complication after anterior cervical spine surgery. However, the quoted frequency of this varies considerably, and the cause of the injury is not clearly defined. As a result, various, and at times contradictory, recommendations to prevent this are presented without data to support their effectiveness.
Data gathered at the time of surgery and during follow-up visits on 900 consecutive patients who underwent anterior cervical spine surgery with plating during a 12-year interval were entered into a computerized database and reviewed for complications and procedural risk factors. After the first 250 cases an intervention consisting of monitoring ET cuff pressure and release of pressure after retractor replacement or repositioning was used, which allowed the ET to recenter within the larynx. The ET-laryngeal wall relation also was studied in fresh intubated cadavers using videofluoroscopic images, before and after retractor placement.
Thirty incidences of vocal cord paralysis consistent with recurrent laryngeal nerve (RLN) injury were identified: 27 temporary and 3 permanent. The rate of temporary paralysis decreased from 6.4% to 1.69% (P = 0.0002) after institution of the described maneuver. The findings confirmed that the retractor displaced the larynx against the shaft of the ET, allowing impingement on the vulnerable intralaryngeal segment of the RLN.
The most common cause of vocal cord paralysis after anterior cervical spine surgery is compression of the RLN within the endolarynx. Monitoring of ET cuff pressure and release after retractor placement may prevent injury to the RLN during anterior cervical spine surgery.
对同期获取的临床数据进行回顾性分析，并辅以实验性尸体解剖。
确定颈椎前路手术后声带麻痹的发生率及机制，并确定控制颈椎牵开系统引起的气管插管（ET）与喉壁相互作用是否能降低麻痹发生率。
声带麻痹是颈椎前路手术后最常见的耳鼻喉科并发症。然而，其报道的发生率差异很大，损伤原因也未明确界定。因此，提出了各种有时相互矛盾的预防建议，但缺乏数据支持其有效性。
将12年间连续900例行颈椎前路钢板固定手术患者的手术及随访数据录入计算机数据库，分析并发症及手术风险因素。在前250例病例之后，采用了一项干预措施，即监测ET套囊压力，并在更换或重新放置牵开器后释放压力，以使ET在喉内重新居中。还利用视频荧光图像在新鲜插管尸体上研究了放置牵开器前后ET与喉壁的关系。
确定了30例符合喉返神经（RLN）损伤的声带麻痹病例：27例为暂时性，3例为永久性。采取上述措施后，暂时性麻痹发生率从6.4%降至1.69%（P = 0.0002）。研究结果证实，牵开器将喉向ET轴方向推移，从而压迫RLN易受损的喉内段。
颈椎前路手术后声带麻痹最常见的原因是喉内RLN受压。监测ET套囊压力并在放置牵开器后释放压力，可能预防颈椎前路手术中RLN损伤。
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