【摘要】：目的對(duì)比觀察頸前路減壓融合術(shù)中重建前縱韌帶-頸長(zhǎng)肌復(fù)合體對(duì)患者術(shù)后早期吞咽功能的影響,并進(jìn)一步探討影響術(shù)后吞咽功能的相關(guān)因素。方法選擇2012年10-2014年10月我科收治的單節(jié)段或鄰近雙節(jié)段病變的頸椎病患者316例,其中術(shù)后能夠得到完整隨訪(fǎng)的患者共有241例。根據(jù)術(shù)中對(duì)頸長(zhǎng)肌及前縱韌帶處理方式不同將241例頸椎病患者分為縫合組(A組,129例)和不縫合組(B組,112例),然后依據(jù)手術(shù)節(jié)段將樣本分為單節(jié)段縫合組(A1,72例)、連續(xù)雙節(jié)段縫合組(A2,57例)、單節(jié)段未縫合組(B1,62例)和連續(xù)雙節(jié)段未縫合組(B2,50例)。通過(guò)對(duì)比分析各組患者在術(shù)后第2天、術(shù)后1周、1個(gè)月、3個(gè)月及6個(gè)月隨訪(fǎng)時(shí)的吞咽困難發(fā)生率、吞咽-生活質(zhì)量(Swallowing Quality Of Life, SWAL-QOL)評(píng)分及椎前軟組織平均厚度的變化情況。結(jié)果術(shù)后第2天、術(shù)后1周、1個(gè)月隨訪(fǎng)時(shí),A1組患者的吞咽困難發(fā)生率均分別低于B1組和A2組(p0.05),Al組患者的SWAL-QOL評(píng)分均分別高于Bl、A2兩組(p0.05),而B(niǎo)2組患者的吞咽困難發(fā)生率均分別高于B1、A2兩組(p0.05),B2組患者的SWAL-QOL評(píng)分均分別低于Bl、A2兩組(p0.05)。術(shù)后3、6個(gè)月隨訪(fǎng)時(shí),各組患者的吞咽困難發(fā)生率及SWAL-QOL評(píng)分在組間進(jìn)行兩兩比較后均無(wú)統(tǒng)計(jì)學(xué)差異(p0.05)。在手術(shù)前后各次隨訪(fǎng)時(shí)各組間患者的椎前軟組織平均厚度變化比較均無(wú)統(tǒng)計(jì)學(xué)差異(p0.05)。結(jié)論頸前路減壓、植骨融合內(nèi)固定術(shù)中重建前縱韌帶-頸長(zhǎng)肌復(fù)合體能夠有效的減少術(shù)后早期吞咽困難發(fā)生率,且相鄰雙節(jié)段手術(shù)患者術(shù)后吞咽困難發(fā)生率高于單節(jié)段患者。
[Abstract]:Objective to observe the effect of anterior longitudinal ligament-longissimus complex reconstruction in anterior cervical decompression and fusion on the early swallowing function of patients after operation, and to further explore the related factors affecting postoperative swallowing function. Methods from October 2012 to October 2014, 316 patients with cervical spondylosis with single or adjacent double segment lesions were enrolled in our department. Totally 241 patients were able to be followed up completely after operation. 241 cases of cervical spondylosis were divided into suture group (group A, 129 cases) and non-suture group (group B, 112 cases) according to the different management methods of the longus cervicalis and anterior longitudinal ligament during operation, and then the samples were divided into single segment suture group (A1, 72 cases) according to the operative segment. Continuous double segment suture group (A 2, 57 cases), single segment unsutured group (B 1, 62 cases) and continuous double segment suture group (B 2, 50 cases). The incidence of dysphagia, swallowing-quality of life (Swallowing Quality Of Life,) during follow-up of 2 days, 1 week, 1 month, 3 months and 6 months after operation in each group were compared and analyzed. SWAL-QOL score and the change of average thickness of prevertebral soft tissue. Results at 2 days, 1 week and 1 month follow-up, the incidence of dysphagia in A1 group was lower than that in B1 group and A2 group, respectively. The SWAL-QOL scores in p0.05), Al group were higher than those in Bl,A2 group (p0.05), and the incidence of dysphagia in A1 group was higher than that in Bl,A2 group (p0.05). The incidence of dysphagia in group B2 was higher than that in group B1, the scores of SWAL-QOL in group A2 (p0.05) and group B2 were lower than those in group Bl,A2 (p0.05). There was no significant difference in the incidence of dysphagia and SWAL-QOL score between groups 3 and 6 months after operation (p0.05). There was no significant difference in the mean thickness of prevertebral soft tissue between groups before and after operation (p0.05). Conclusion anterior cervical decompression and internal fixation with bone graft fusion can effectively reduce the incidence of dysphagia in early postoperative patients, and the incidence of dysphagia in adjacent bi-segmental surgery is higher than that in single segment.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R687.3

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本文編號(hào)：2458832