Department of Spinal Surgery, Xinxiang Central Hospital, Xinxiang, China.
Department of Spinal Surgery, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China.
Orthop Surg. 2024 Oct;16(10):2391-2400. doi: 10.1111/os.14166. Epub 2024 Jul 18.
Dysphagia, an impairment in swallowing, is a frequent and debilitating complication for patients undergoing anterior cervical discectomy and fusion (ACDF), a common surgical treatment for degenerative cervical myelopathy (DCM). This retrospective study aimed to assess the efficacy of modified tracheal traction exercise (MTTE) in alleviating postoperative dysphagia and improving clinical outcomes for these patients.
A cohort of 143 patients underwent multilevel fusions, equally distributed between MTTE (n = 75) and traditional tracheal traction exercise (TTTE) (n = 68) groups. Demographic parity was observed in gender distribution, age averages (MTTE: 51.43 ± 11.25 years; TTTE: 52.35 ± 10.43 years), body mass index (BMI), comorbidities, fusion segments, and preoperative hospitalization days. Surgical duration differences were assessed. Clinical outcomes, dysphagia incidence, blood loss, postoperative complications, Cervical Japanese Orthopedic Association (c-JOA) scores, and functional outcome swallowing scale evaluations were conducted. Univariate and multivariate logistic regression analyses were used to explore factors influencing dysphagia.
Modified tracheal traction exercise demonstrated advantages with a significantly lower dysphagia incidence (25.33% vs. 44.12%, p = 0.018), reduced blood loss (102.03 ± 17.04 vs. 113.46 ± 14.92, p < 0.001), shorter surgical durations (159.04 ± 9.82 vs. 164.41 ± 12.22 min, p = 0.004), and fewer postoperative complications (choking cough, cerebrospinal fluid leakage, and hoarseness). Postoperative c-JOA scores at 2 and 6 weeks favored MTTE, but no significant differences were observed at 12 and 24 weeks. Functional outcome swallowing scale evaluations favored MTTE with significantly higher percentages of "normal" and lower incidences of "mild" and "moderate dysphagia" at various postoperative intervals compared to TTTE. Factors significantly associated with dysphagia included MTTE, age, and BMI according to logistic regression analyses.
Modified tracheal traction exercise demonstrates superior short-term outcomes in multilevel ACDF, showcasing reduced dysphagia incidence, blood loss, and specific postoperative complications. Notably, factors contributing to dysphagia, including operation technique and patient-related variables, emphasize the significance of MTTE and patient characteristics in optimizing postoperative outcomes in multilevel ACDF procedures.
吞咽困难是颈椎前路椎间盘切除融合术（ACDF）后常见且使人虚弱的并发症，该手术是治疗退行性颈椎病（DCM）的常用方法。本回顾性研究旨在评估改良气管牵引运动（MTTE）在减轻术后吞咽困难和改善这些患者的临床结果方面的效果。
一组 143 名患者接受了多节段融合，分为 MTTE（n=75）和传统气管牵引运动（TTTE）（n=68）组。观察两组患者在性别分布、年龄平均水平（MTTE：51.43±11.25 岁；TTTE：52.35±10.43 岁）、体重指数（BMI）、合并症、融合节段和术前住院天数方面的均衡性。评估手术时间差异。进行临床结果、吞咽困难发生率、出血量、术后并发症、颈椎日本骨科协会（c-JOA）评分和功能吞咽量表评估。采用单变量和多变量逻辑回归分析探讨影响吞咽困难的因素。
改良气管牵引运动具有明显优势，吞咽困难发生率较低（25.33%比 44.12%，p=0.018），出血量较少（102.03±17.04 比 113.46±14.92，p<0.001），手术时间较短（159.04±9.82 比 164.41±12.22 分钟，p=0.004），术后并发症较少（呛咳、脑脊液漏和声音嘶哑）。术后 2 周和 6 周的 c-JOA 评分有利于 MTTE，但术后 12 周和 24 周没有明显差异。功能吞咽量表评估也有利于 MTTE，与 TTTE 相比，在各个术后时间点，MTTE 组“正常”的比例明显更高，“轻度”和“中度吞咽困难”的发生率更低。Logistic 回归分析表明，与吞咽困难相关的因素包括 MTTE、年龄和 BMI。
改良气管牵引运动在多节段 ACDF 中具有更好的短期结果，显示出较低的吞咽困难发生率、出血量和特定的术后并发症。值得注意的是，导致吞咽困难的因素，包括手术技术和患者相关变量，强调了 MTTE 和患者特征在优化多节段 ACDF 术后结果方面的重要性。
