Mitsuishi Takayuki, Ishihara Yoshihito
Department of Physical Medicine and Rehabilitation, Yonemori Hospital, Kagoshima, Japan.
Department of Rehabilitation Unit, Yonemori Hospital, Kagoshima, Japan.
Prog Rehabil Med. 2019 Nov 1;4:20190019. doi: 10.2490/prm.20190019. eCollection 2019.
The objectives of this study were to clarify whether prevertebral soft tissue (PVST) thickening increases the risk of dysphagia, to identify at which vertebral level determining PVST thickness is useful, and to determine cutoff values.
A total of 80 patients with traumatic cervical spinal cord injury (TCSCI) treated over a 43-month period at a single regional institution specializing in cervical spinal cord injuries participated in the study. The exclusion criteria were having undergone anterior cervical spine surgery; a history of complicated traumatic brain injury, complicated vertebral artery injury, or brain injury; endotracheal intubation at day 30 after onset; the disappearance of neurological symptoms within 24 hours after onset; and the use of a halo vest. The associations between PVST thicknesses at C1, C2, C3, C6, and C7 measured by CT on the day of onset and the presence of dysphagia (Food Intake LEVEL Scale score <8) at 30 and 60 days after onset of TCSCI were analyzed using ROC curves to calculate the maximum area under the curve and the PVST cutoff values for these vertebrae. Associations between various risk factors, including PVST thickness, and dysphagia at days 30 and 60 after onset were examined using univariate and multivariate analyses.
Independent associations with dysphagia were found with the C3 PVST thickness (day 30: ≥8.3 mm, day 60: ≥9.4 mm) and tracheostomy.
PVST thickness or injury seems to be an independent risk factor for dysphagia. By measuring PVST, it is possible to estimate the severity of dysphagia even in acute conditions.
本研究的目的是阐明椎前软组织（PVST）增厚是否会增加吞咽困难的风险，确定在哪个椎体水平测量PVST厚度是有用的，并确定临界值。
在一家专门治疗颈脊髓损伤的地区性机构，对43个月内治疗的80例创伤性颈脊髓损伤（TCSCI）患者进行了研究。排除标准为曾接受过颈椎前路手术；有复杂创伤性脑损伤、复杂椎动脉损伤或脑损伤病史；发病后30天内行气管插管；发病后24小时内神经症状消失；以及使用了头环背心。使用ROC曲线分析发病当天CT测量的C1、C2、C3、C6和C7水平的PVST厚度与TCSCI发病后30天和60天吞咽困难（食物摄入水平量表评分<8）的存在之间的关联，以计算最大曲线下面积和这些椎体的PVST临界值。使用单因素和多因素分析检查包括PVST厚度在内的各种危险因素与发病后30天和60天吞咽困难之间的关联。
发现与吞咽困难独立相关的因素为C3水平的PVST厚度（30天：≥8.3 mm，60天：≥9.4 mm）和气管切开术。
PVST厚度或损伤似乎是吞咽困难的独立危险因素。通过测量PVST，即使在急性情况下也有可能估计吞咽困难的严重程度。
