Department of Orthopedics Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China.
Department of Orthopedics Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China.
Spine J. 2019 Aug;19(8):1362-1368. doi: 10.1016/j.spinee.2019.04.002. Epub 2019 Apr 10.
Dysphagia is a complication that sometimes occurs after occipitocervical fusion (OCF). An appropriate O-C2 angle (O-C2a) is recognized as a critical factor for preventing dysphagia. The occiput and external acoustic meatus to axis angle (O-EAa) has some advantages over the O-C2a and is now recognized to outperform O-C2a in predicting dysphagia. However, there are no data on this topic from patients with anterior atlantoaxial subluxation (AAS).
To evaluate the relationship between the O-EAa and dysphagia in patients suffering from AAS after OCF surgery.
A retrospective clinical study.
Data from 22 consecutive AAS patients who had undergone OCF were reviewed retrospectively.
The outcome measures included the O-EAa, O-C2a, the narrowest oropharyngeal airway space (nPAS), and the morbidity of dysphagia after OCF.
Between September 2011 and September 2017, data from 22 consecutive AAS patients who had undergone OCF were reviewed retrospectively. The patients were divided into two groups according to whether they had suffered postoperative dysphagia by face-to-face questioning or telephone interview. Lateral radiographs were analyzed to determine the pre- and postoperative O-EAa, O-C2a, angle formed by the inferior endplate of C2 and the EA-line (C2Ta), and smallest anteroposterior diameter of the oropharynx between the levels of the uvula and the tip of the epiglottis (nPAS).
The incidence of dysphagia after OCF was 18.18% (4/22). The pre- and postoperative mean nPAS values were significantly different between the groups (p<.05). The postoperative mean O-EAa of the group with dysphagia was significantly smaller than that of the group without dysphagia (p<.05). The mean change in nPAS was significantly larger in the group with dysphagia than that in the group without dysphagia (p<.05). The changes in the O-EAa, O-C2a, and nPAS were linearly correlated within patients. The marginal R values for the patients were 0.452 and 0.202 for the O-EAa and O-C2a, respectively.
The O-EAa impacts dysphagia in patients with AAS after OCF. Measuring this angle intraoperatively may be a simple and effective procedure. The O-EAa may be used as a practical index to avoid postoperative dysphagia in patients with AAS after OCF.
吞咽困难是枕颈融合（OCF）后偶尔出现的并发症。合适的枕骨髁-颈 2 角（O-C2a）被认为是预防吞咽困难的关键因素。枕外孔-外耳道轴角（O-EAa）比 O-C2a 有一些优势，现在被认为在预测吞咽困难方面优于 O-C2a。然而，对于前寰枢椎半脱位（AAS）患者，尚无关于该主题的数据。
评估 OCF 术后 AAS 患者的 O-EAa 与吞咽困难之间的关系。
回顾性临床研究。
回顾性分析 22 例连续接受 OCF 的 AAS 患者的数据。
结局指标包括 O-EAa、O-C2a、最小口咽气道空间（nPAS）和 OCF 术后吞咽困难的发病率。
2011 年 9 月至 2017 年 9 月，回顾性分析 22 例连续接受 OCF 的 AAS 患者的数据。根据是否通过面对面询问或电话访谈确认术后吞咽困难，将患者分为两组。通过侧位 X 线片分析确定术前和术后 O-EAa、O-C2a、C2 下终板与 EA 线（C2Ta）形成的角度以及在悬雍垂和会厌尖端水平之间的口咽最窄前后径（nPAS）。
OCF 术后吞咽困难的发生率为 18.18%（4/22）。两组间术前和术后平均 nPAS 值差异有统计学意义（p<.05）。吞咽困难组术后平均 O-EAa 明显小于无吞咽困难组（p<.05）。吞咽困难组 nPAS 的平均变化明显大于无吞咽困难组（p<.05）。患者的 O-EAa、O-C2a 和 nPAS 的变化在患者内部呈线性相关。患者的边缘 R 值分别为 O-EAa 和 O-C2a 的 0.452 和 0.202。
O-EAa 影响 OCF 后 AAS 患者的吞咽困难。术中测量该角度可能是一种简单有效的方法。O-EAa 可作为 OCF 后 AAS 患者避免术后吞咽困难的实用指标。
