Department of Orthopaedic Surgery, Kobe Rosai Hospital, Kobe, Japan.
OrthoCarolina Spine Center, Charlotte, NC.
Spine (Phila Pa 1976). 2017 May 15;42(10):718-725. doi: 10.1097/BRS.0000000000001963.
Clinical case series and risk factor analysis of dysphagia after occipitospinal fusion (OSF).
The aim of this study was to develop new criteria to avoid postoperative dysphagia by analyzing the relationship among the craniocervical alignment, the oropharyngeal space, and the incidence of dysphagia after OSF.
Craniocervical malalignment after OSF is considered to be one of the primary triggers of postoperative dysphagia. However, ideal craniocervical alignment has not been confirmed.
Thirty-eight patients were included. We measured the O-C2 angle (O-C2A) and the pharyngeal inlet angle (PIA) on the lateral cervical radiogram at follow-up. PIA is defined as the angle between McGregor's line and the line that links the center of the C1 anterior arch and the apex of cervical sagittal curvature. The impact of these two parameters on the diameter of pharyngeal airway space (PAS) and the incidence of the dysphagia were analyzed.
Six of 38 cases (15.8%) exhibited the dysphagia. A multiple regression analysis showed that PIA was significantly correlated with PAS (β = 0.714, P = 0.005). Receiver-operating characteristic curves showed that PIA had a high accuracy as a predictor of the dysphagia with an AUC (area under the curve) of 0.90. Cases with a PIA less than 90 degrees showed significantly higher incidence of dysphagia (31.6%) than those with a 90 or more degrees of PIA (0.0%) (P = 0.008).
Our results indicated that PIA had the high possibility to predict postoperative dysphagia by OSF with the condition of PIA <90°. Based on these results, we defined "Swallowing-line (S-line)" for the reference of 90° of PIA. S-line (-) is defined as PIA <90°, where the apex of cervical lordosis protruded anterior to the "S-line," which should indicate the patient is at a risk of postoperative dysphagia.
枕颈融合术后吞咽困难的临床病例系列及危险因素分析。
本研究旨在通过分析颅颈矢状面关系、咽腔空间与枕颈融合术后吞咽困难的关系，提出避免术后吞咽困难的新标准。
枕颈融合术后颅颈失平衡被认为是术后吞咽困难的主要触发因素之一，但理想的颅颈矢状面尚未得到证实。
共纳入 38 例患者，在随访时测量侧位颈椎 X 线片上的寰齿关节距（O-C2A）和咽腔入口角（PIA）。PIA 定义为 McGregor 线与连接 C1 前弓中心和颈椎矢状曲度顶点的线之间的夹角。分析这两个参数对咽腔气道空间（PAS）直径和吞咽困难发生率的影响。
38 例中有 6 例（15.8%）出现吞咽困难。多元回归分析显示，PIA 与 PAS 显著相关（β=0.714，P=0.005）。受试者工作特征曲线显示，PIA 作为吞咽困难的预测指标具有较高的准确性，曲线下面积（AUC）为 0.90。PIA 小于 90 度的患者吞咽困难发生率明显高于 PIA 为 90 度或以上的患者（31.6%比 0.0%）（P=0.008）。
我们的结果表明，PIA 有很大可能通过 PIA <90°来预测枕颈融合术后吞咽困难。基于这些结果，我们定义了“吞咽线（S 线）”作为 PIA 90°的参考。S 线（-）定义为 PIA <90°，此时颈椎前凸顶点位于“S 线”前方，表明患者存在术后吞咽困难的风险。
4 级。
