Chen Yufan, Xu Weihong
Department of Orthopedics, Fujian Provincial Clinical Medical Research Center for Trauma Orthopedics Emergency and Rehabilitation, Fuzhou Second General Hospital, Fuzhou, 350007, China.
Department of Spine Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, China.
J Orthop Surg Res. 2025 Jan 23;20(1):89. doi: 10.1186/s13018-025-05516-6.
To analyze the risk factors for developing dysphagia after occipitocervical fusion (OCF) and investigate possible mechanisms and prognosis.
The case data of 43 patients who underwent OCF were retrospectively reviewed. Patients were divided into group A (dysphagia group) and group B (non-dysphagia group) based on Bazaz scoring criteria. Baseline data and imaging parameters were collected: O-C2 angle, C2-7 angle, pharyngeal inlet angle (PIA), posterior occipital cervical angle (POCA), O-EA angle, Oc-Ax angle, Atlas-dens interval, C2-7 sagittal vertical axis (SVA), T1 slope, narrowest oropharyngeal airway space (nPAS), and thickness of the prevertebral soft tissue. Potential risk factors were identified via one-way intergroup comparisons and included in multivariable logistic regression analysis. Pearson or Spearman correlation analysis was performed to assess associations between dnPAS% and each parameter and inter-parameter correlations. Predictors were selected to plot receiver operating characteristic (ROC) curves for diagnostic evaluation. Prognosis was analyzed using the Kaplan-Meier method and curvilinear regression.
Dysphagia occurred in 17 of 43 patients (39.53%). By the final follow-up (≥ 12 months), 11 patients (25.58%) had residual symptoms. Baseline factors, including dyspnea (P = 0.028), operative segment (P = 0.021), operative time (P = 0.006), anesthesia time (P = 0.025), solitude (P = 0.019), and satisfaction (P < 0.001), differed significantly between groups. Imaging parameters dO-C2a (P < 0.001), dPOCA (P < 0.001), PoPIA (P = 0.036), dPIA (P < 0.001), dOc-Axa (P = 0.001), dC2-7 SVA (P = 0.040), PonPAS (P = 0.004), dnPAS (P = 0.005), and dnPAS% (P < 0.001) were also significantly different. Multivariable regression analysis identified dPIA (OR = 0.870, P = 0.008) as an independent protective factor. ROC analysis showed dPIA had good diagnostic value (AUC = 0.855) with a cutoff of -8°. Prognostic analysis indicated rapid recovery was possible by 3 months postoperatively, with full recovery achieved in ~ 30% of patients by 1 year, after which recovery plateaued.
Postoperative dysphagia after OCF appears to result from multiple factors involving both "static + dynamic" elements. dPIA is a reliable predictor, with patients having a dPIA >-8° being less likely to develop dysphagia. However, only ~ 30% of patients achieve full recovery.
分析枕颈融合术（OCF）后发生吞咽困难的危险因素，探讨可能的机制及预后情况。
回顾性分析43例行OCF患者的病例资料。根据Bazaz评分标准将患者分为A组（吞咽困难组）和B组（无吞咽困难组）。收集基线数据和影像学参数：枕骨至C2角、C2至C7角、咽入口角（PIA）、枕后颈椎角（POCA）、枕骨至食管角、枕骨至枢椎角、寰椎前弓后缘至齿突间距、C2至C7矢状垂直轴（SVA）、T1斜率、最窄口咽气道间隙（nPAS）及椎前软组织厚度。通过组间单因素比较确定潜在危险因素，并纳入多因素logistic回归分析。采用Pearson或Spearman相关性分析评估dnPAS%与各参数之间的相关性以及参数间的相关性。选择预测指标绘制受试者工作特征（ROC）曲线进行诊断评估。采用Kaplan-Meier法和曲线回归分析预后情况。
43例患者中17例（39.53%）发生吞咽困难。至末次随访（≥12个月）时，11例患者（25.58%）仍有残留症状。两组间基线因素包括呼吸困难（P = 0.028）、手术节段（P = 0.021）、手术时间（P = 0.006）、麻醉时间（P = 0.025）、孤独感（P = 0.019）及满意度（P < 0.001）差异有统计学意义。影像学参数dO-C2a（P < 0.001）、dPOCA（P < 0.001）、PoPIA（P = 0.036）、dPIA（P < 0.001）、dOc-Axa（P = 0.001）、dC2-7 SVA（P = 0.040）、PonPAS（P = 0.004）、dnPAS（P = 0.005）及dnPAS%（P < 0.001）也有显著差异。多因素回归分析确定dPIA（OR = 0.870，P = 0.008）为独立保护因素。ROC分析显示dPIA具有良好的诊断价值（AUC = 0.855），截断值为-8°。预后分析表明术后3个月内恢复可能较快，1年时约30%的患者可完全恢复，此后恢复趋于平稳。
OCF术后吞咽困难似乎是由涉及“静态 + 动态”因素的多种因素导致。dPIA是可靠的预测指标，dPIA > -8°的患者发生吞咽困难的可能性较小。然而，只有约30%的患者可完全恢复。
