Shi Sheng, Li Xin-Feng, Zhao Qi-Tong, Yang Li-Li, Liu Zu-De, Yuan Wen
Department of Orthopaedic Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, People's Republic of China.
Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China.
World Neurosurg. 2016 Nov;95:148-155. doi: 10.1016/j.wneu.2016.07.100. Epub 2016 Aug 6.
To determine any differences in self-reported dysphagia in patients treated with single-level anterior cervical decompression with different zero-profile implants (arthroplasty vs. arthrodesis) and identify risk factors for postoperative dysphagia.
A total of 112 patients with 1-level cervical degenerative disc disease were included in the prospective study. The dysphagia conditions and radiologic results were assessed using Bazar dysphagia scoring system, the Swallowing Quality of Life scores, cervical alignment (CA), segmental angle, and prevertebral soft tissues swelling (PSTS). All these parameters were compared before and after surgery in the respective group, which were also compared between the 2 groups. Correlations between the confounding factors and postoperative dysphagia were analyzed.
No significant differences existed in preoperative or initially postoperative dysphagia rate and scores between the 2 groups (P > 0.05). However, the dysphagia rate and scores of cervical disc arthroplasty was better than those of fusion at postoperative day 7. Heavy smoker, PSTS change (≥5 mm), or CA change (≥5 degrees) was prone to have postoperative dysphagia.
Postoperative dysphagia remains a common incidence, despite advances in instrumentation technologies. However, cervical disc arthroplasty is superior to anterior cervical discectomy and fusion in ameliorating the symptom of dysphagia in the early postoperative term. Heavy smoker, PSTS change (≥5 mm), and CA change (≥5 degrees) were important predictors of postoperative dysphagia.
确定采用不同零切迹植入物（人工关节成形术与融合术）进行单节段颈椎前路减压治疗的患者在自我报告的吞咽困难方面是否存在差异，并确定术后吞咽困难的危险因素。
共有112例1节段颈椎退行性椎间盘疾病患者纳入前瞻性研究。使用巴扎尔吞咽困难评分系统、吞咽生活质量评分、颈椎对线（CA）、节段角度和椎体前软组织肿胀（PSTS）评估吞咽困难情况和放射学结果。在各自组内比较所有这些参数在手术前后的情况，同时也在两组之间进行比较。分析混杂因素与术后吞咽困难之间的相关性。
两组术前或术后初期的吞咽困难发生率和评分无显著差异（P>0.05）。然而，在术后第7天，颈椎间盘人工关节成形术的吞咽困难发生率和评分优于融合术。重度吸烟者、PSTS变化（≥5mm）或CA变化（≥5度）更容易出现术后吞咽困难。
尽管器械技术有所进步，但术后吞咽困难仍然是常见的情况。然而，在术后早期改善吞咽困难症状方面，颈椎间盘人工关节成形术优于颈椎前路椎间盘切除融合术。重度吸烟者、PSTS变化（≥5mm）和CA变化（≥5度）是术后吞咽困难重要的预测因素。
