Department of Gastroenterology, Lihuili Hospital of Ningbo Medical Center, Ningbo, Zhejiang, PR China.
Department of Orthopedic Surgery, Lihuili Hospital of Ningbo Medical Center, #57, Xingning Road, Yinzhou District, Ningbo, Zhejiang, PR China.
BMC Musculoskelet Disord. 2023 Sep 9;24(1):720. doi: 10.1186/s12891-023-06843-7.
This study aimed to analyze the change trends of prevertebral soft tissue swelling (PSTS) for anterior cervical corpectomy fusion(ACCF) and to evaluate the risk factors of PSTS for postoperative dysphagia.
There were 309 patients with degenerative cervical diseases who were treated with ACCF from November 2015 and September 2019 in our hospital. According to the symptom of swallowing function after ACCF, those were divided into the dysphagia group and the normal-swallowing function group. Cervical computed tomography(CT) was analyzed, and radiological evaluation of the prevertebral soft tissue was measured between the antero-inferior corner of each vertebral body and the air shadow of the airway through CT mid-sagittal slice images before operation and after operation(one week, one month, eight months and twelve months).
The incidence of dysphagia after ACCF was 41.1%. 120 of 127(94.5%) patients had dysphagia disappeared at the 8 months after ACCF, and all disappeared at the 12 months. In both groups, PSTS would be biggest at 1 week postoperatively comparing to the preoperative, and then get smaller from 1 week to 12 months postoperatively (p < 0.05). After 12 months of operation, the PSTS of all cervical spinal levels would get equal to the preoperative size in the normal-swallowing function group, while the PSTS in dysphagia group would get equal only in C5-7 levels. The PSTS of preoperative C6 level and postoperative C2 level were more closely related to the present of postoperative dysphagia (OR: 9.403, 95%CI: 2.344-37.719, OR: 3.187, 95%CI: 1.78-5.705). It was more important to predict postoperative dysphagia using the value of PSTS at preoperative C6 level and postoperative C2 level, with the cutoff threshold for the PSTS of preoperative C6 level ≦1.51 cm and postoperative C2 level ≦1.3915 cm, which could get sensitivity & specificity 66.929% and 61.54%, 77.17% and 64.29%, respectively.
Our study showed that the increasing of the PSTS after ACCF should be considered as a risk factor of dysphagia after surgery. With the recovery of PSTS over time, the incidence of postoperative dysphagia decreases. The PSTS of preoperative C6 level and and postoperative C2 level should play an important part in predicting the risk of postoperative dysphagia.
本研究旨在分析颈椎前路椎体次全切除融合术（ACCF）前后椎体前方软组织肿胀（PSTS）的变化趋势，并评估 PSTS 与术后吞咽困难的关系。
2015 年 11 月至 2019 年 9 月，我院收治的 309 例退行性颈椎疾病患者行 ACCF 治疗。根据术后吞咽功能，将患者分为吞咽困难组和正常吞咽功能组。对颈椎 CT 进行分析，通过 CT 正中矢状位图像测量术前和术后（术后 1 周、1 个月、8 个月和 12 个月）每个椎体前下缘与气道空气影之间的椎体前方软组织。
ACCF 后吞咽困难的发生率为 41.1%。127 例患者中有 120 例（94.5%）在 ACCF 后 8 个月吞咽困难消失，所有患者在 12 个月时吞咽困难均消失。两组患者术后 1 周 PSTS 均大于术前，术后 1 周至 12 个月 PSTS 逐渐减小（p<0.05）。术后 12 个月，正常吞咽功能组各颈椎节段的 PSTS 均恢复至术前水平，而吞咽困难组仅 C5-7 节段恢复至术前水平。术前 C6 水平和术后 C2 水平的 PSTS 与术后吞咽困难的发生更为密切（OR：9.403，95%CI：2.344-37.719，OR：3.187，95%CI：1.78-5.705）。术前 C6 水平和术后 C2 水平 PSTS 值对术后吞咽困难的预测更为重要，术前 C6 水平 PSTS 值≦1.51cm 和术后 C2 水平 PSTS 值≦1.3915cm 的截断值，其敏感性和特异性分别为 66.929%和 61.54%、77.17%和 64.29%。
本研究表明，ACCF 后 PSTS 的增加应被视为术后吞咽困难的危险因素。随着 PSTS 随时间的恢复，术后吞咽困难的发生率降低。术前 C6 水平和术后 C2 水平的 PSTS 应在预测术后吞咽困难风险中发挥重要作用。
