Chin Kingsley R, Eiszner James R, Adams Samuel B
Division of Spine Surgery, Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania and the University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
Spine (Phila Pa 1976). 2007 Nov 1;32(23):2585-90. doi: 10.1097/BRS.0b013e318158dec8.
Prospective radiographic analysis with clinical correlates.
The purpose of this study was to determine whether patients with cervical plates protruding off the vertebral body more prominently than pre-existing osteophytes had higher rates of dysphagia, suggesting a mechanical role.
Plate prominence due to mechanical causes has been implicated as a cause of dysphagia after anterior cervical fusion. This study therefore assessed the potential of plate prominence as a cause of dysphagia after anterior cervical fusion and the predictive role of preoperative osteophyte heights.
Osteophyte heights measured on the preoperative radiographs of 63 patients, 41 males and 23 females with mean age 54 years (range, 31 to 75), who underwent anterior fusion (2 mm SYNTHES CSLP plates). After surgery, the distance of the plate from the vertebral body was measured and compared with preoperative osteophyte heights. Group I contained 30 patients who had cervical plates protrude less than or equal to the height of the tallest preoperative osteophyte. Group II contained 34 patients who had plates protrude greater than the height of the tallest preoperative osteophyte.
No patients had preoperative dysphagia. Five of 30 Group I patients had dysphagia (>1 month). Six of 34 group II patients had dysphagia. There was no difference between groups I and II in rate of dysphagia (beta > 0.90). Plates at C3 and shorter cervical constructs trended higher rates of dysphagia.
Long-term postoperative dysphagia in Group I patients and the lack of a difference in rates of dysphagia between group I and group II, made it improbable plate thickness of 2 mm or prominence between 3 and 7 mm consistently played roles in dysphagia. Preoperative osteophyte height did not predict which patients developed postoperative dysphagia. Plates at the C3 and shorter constructs trended to have higher rates of dysphagia.
前瞻性影像学分析及临床相关性研究。
本研究旨在确定颈椎钢板突出于椎体的程度比原有骨赘更显著的患者是否有更高的吞咽困难发生率，以提示其机械性作用。
机械性原因导致的钢板突出被认为是颈椎前路融合术后吞咽困难的一个原因。因此，本研究评估了钢板突出作为颈椎前路融合术后吞咽困难原因的可能性以及术前骨赘高度的预测作用。
对63例患者（41例男性，23例女性，平均年龄54岁，范围31至75岁）的术前X线片测量骨赘高度，这些患者均接受了前路融合术（使用2毫米的SYNTHES CSLP钢板）。术后，测量钢板与椎体的距离，并与术前骨赘高度进行比较。第一组包括30例颈椎钢板突出小于或等于术前最高骨赘高度的患者。第二组包括34例钢板突出大于术前最高骨赘高度的患者。
所有患者术前均无吞咽困难。第一组30例患者中有5例出现吞咽困难（超过1个月）。第二组34例患者中有6例出现吞咽困难。第一组和第二组在吞咽困难发生率上无差异（β>0.90）。C3节段及较短颈椎结构的钢板吞咽困难发生率有升高趋势。
第一组患者术后长期出现吞咽困难，且第一组和第二组在吞咽困难发生率上无差异，这使得2毫米厚的钢板或3至7毫米的突出程度不太可能一直是吞咽困难的原因。术前骨赘高度无法预测哪些患者会发生术后吞咽困难。C3节段及较短结构的钢板吞咽困难发生率有升高趋势。
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