Zou Qiang, Wang Linnan, Yang Xi, Song Yueming, Liu Limin, Wang Lei, Zhou Zhongjie, Hu Bowen, Liu Hao, Chen Taiyong
Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;Orthopedic Research Institute of West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2021 Jan 15;35(1):33-38. doi: 10.7507/1002-1892.202007113.
To compare the predictive abilities of O-C2 angle (O-C2a), O-EA angle (O-EAa), and Oc-Ax angle (Oc-Axa) for development of dysphagia in patients after occipitocervical fusion (OCF).
Between April 2010 and May 2019, 114 patients who underwent OCF and met the selection criteria were selected as the research objects. Among them, 54 were males and 60 were females; they were 14-76 years old, with an average of 50.6 years old. The follow-up time was 13-122 months (median, 60.5 months). The O-C2a, O-EAa, Oc-Axa, and the narrowest oropharyngeal airway space (nPAS) were measured by the lateral X-ray films before operation and at last follow-up, and the differences before and after operation (dO-C2a, dO-EAa, dOc-Axa, and dnPAS) were calculated. Patients were divided into two groups according to whether they had developed postoperative dysphagia. The general data including age, gender, fixed segment, proportion of patients with rheumatoid arthritis (RA), atlantoaxial subluxation (AS), and combined with anterior release surgery (ARS), and imaging indicators were compared between the two groups. The correlations between dO-C2a, dO-EAa, and dOc-Axa and dnPAS in 114 patients were analyzed to further compare the predictive value of three imaging indicators for occurrence of dysphagia after OCF.
Dysphagia occurred after OCF in 31 cases with the incidence of 27.2%. There was significant difference in gender between the dysphagia group and the non-dysphagia group ( =7.940, =0.005). There was no significant difference between the two groups in age, fixed segment, the proportion of patients with RA, the proportion of patients with AS, and the proportion of patients combined with ARS ( >0.05). There was no significant difference in O-C2a and Oc-Axa of 114 patients before operation and at last follow-up ( >0.05). The differences in O-EAa and nPAS were significant ( <0.05). There was no significant difference in preoperative O-EAa, Oc-Axa, and nPAS between the dysphagia group and the non-dysphagia group ( >0.05); the difference in the O-C2a was significant ( =2.470, =0.016). At last follow-up, the differences in the above imaging indicators were significant ( <0.05). There were significant differences in the dO-C2a, dO-EAa, dOc-Axa, and dnPAS between the two groups ( <0.05). Correlation analysis showed that the dO-C2a, dO-EAa, dOc-Axa were all positively correlated with dnPAS ( <0.05). The dO-C2a≤-5°, postoperative O-EAa≤100°, postoperative Oc-Axa≤65° were all related to postoperative dysphagia ( <0.05), and the highest risk factor suffering postoperative dysphagia was dO-C2a ≤-5° with a significant of 14.4.
The dO-C2a, postoperative O-EAa, and postoperative Oc-Axa can be used as the predictive indexes of dysphagia after OCF, among which dO-C2a has the highest predictive value.
比较枕颈融合术（OCF）后患者中O-C2角（O-C2a）、O-EA角（O-EAa）和Oc-Ax角（Oc-Axa）对吞咽困难发生的预测能力。
选取2010年4月至2019年5月期间接受OCF且符合入选标准的114例患者作为研究对象。其中，男性54例，女性60例；年龄14 - 76岁，平均50.6岁。随访时间为13 - 122个月（中位数为60.5个月）。术前及末次随访时通过颈椎侧位X线片测量O-C2a、O-EAa、Oc-Axa及最窄口咽气道间隙（nPAS），并计算手术前后差值（dO-C2a、dO-EAa、dOc-Axa和dnPAS）。根据术后是否发生吞咽困难将患者分为两组。比较两组患者的年龄、性别、固定节段、类风湿关节炎（RA）患者比例、寰枢椎半脱位（AS）患者比例以及是否合并前路松解手术（ARS）等一般资料和影像学指标。分析114例患者中dO-C2a、dO-EAa、dOc-Axa与dnPAS之间的相关性，以进一步比较3项影像学指标对OCF后吞咽困难发生的预测价值。
OCF后31例发生吞咽困难，发生率为27.2%。吞咽困难组与非吞咽困难组性别差异有统计学意义（ =7.940， =0.005）。两组在年龄、固定节段、RA患者比例、AS患者比例及合并ARS患者比例方面差异无统计学意义（ >0.05）。114例患者术前及末次随访时O-C2a和Oc-Axa差异无统计学意义（ >0.05）。O-EAa和nPAS差异有统计学意义（ <0.
