摘要
目的探讨术中局部应用长效糖皮质激素预防颈前路椎体次全切除减压融合术(anterior cervical corpectomy and fusion,ACCF)后吞咽困难的疗效。方法采用随机数表法,将56例须行ACCF术式的颈椎病患者分为治疗组(32例)和对照组(24例),治疗组术中局部给予长效糖皮质激素(地塞米松1 ml:2 mg),对照组相同的方法给予等量的生理盐水。对比两组患者术后1天、2周及12周吞咽困难发生率、吞咽生活质量评分(Swallowing-Quality of Life,SWAL-QOL)及前软组织厚度的改变,比较两组吞咽困难并发症的发生情况。对比两组术后3个月,6个月植骨融合率。结果所有患者均获得完整随访资料。术后1天、2周及12周随访时,治疗组吞咽困难发生率(26.47%,14.7%,2.94%)和椎前软组织厚度[(10.99±1.66)mm,(10.45±1.73)mm,(10.07±1.84)mm]明显低于对照组患者[分别为54.17%,29.17%,8.33%,(11.92±1.59)mm,(11.54±1.59)mm,(11.16±1.63)mm](P<0.05)。术后1天、2周及12周时,治疗组患者SWAL-QOL评分[(59.20±7.23),(61.33±5.24),(63.77±3.37)]明显高于对照组[(53.91±8.99),(59.36±6.33),(62.07±4.51)](P<0.05)。术后3个月随访时,治疗组对照组患者各1例未骨性融合,术后6个月随访均已骨性融合,两组间无统计学差异。结论术中局部应用长效糖皮质激素能有效降低颈前路椎体次全切除减压融合术后吞咽困难的发生率和吞咽困难的严重程度,且不影响术后植骨融合。
Objective To study the effect of local application of long-acting glucocorticoid in the prevention of dysphagia anterior cervical corpectomy and fusion（ ACCF）. Methods Using random number table,56 patients with cervical spondylosis who underwent ACCF operation were divided into treatment group（ 32 cases） and control group（ 24 cases）by random number table method. The treatment group was treated with long-acting corticosteroids（ dexamethasone 1 ml：2 mg） and the control group received the same amount of normal saline by the same method. The incidence of dysphagia,Swallowing-Quality of Life（ SWAL-QOL） score and the thickness of prevertebral soft tissue were compared between the two groups at 1 day,2 and 12 weeks postoperatively. The bone graft fusion rate was compared between the two groups at 3 months and 6 months postoperatively. Results After 1 days,2 weeks and 12 weeks follow-up,the incidence of dysphagia（ 26. 47%,14. 7%,2. 94%） and the thickness of prevertebral soft tissue of the treatment group were significantly lower than those in the control group[54. 17%,29. 17%,8. 33%,（ 11. 92 ± 1. 59） mm,（ 11. 54 ±1. 59） mm,（ 11. 16 ± 1. 63） mm]（ P 〈0. 05）. The SWAL-QOL score of treatment group[（ 59. 20 ± 7. 23）,（ 61. 33 ±5. 24）,（ 63. 77 ± 3. 37） ] is higher at 1 day,2 and 12 weeks after surgery than that of control group[（ 53. 91 ± 8. 99）,（ 59. 36 ± 6. 33）,（ 62. 07 ± 4. 51） ]（ P 〈0. 05）. After 3 months of follow-up,the treatment group and the control group were 1 patients without bony fusion,and 6 months after the operation were followed by bony fusion. There was no statistical difference between the two groups. Conclusion local application of long-acting glucocorticoids can effectively reduce the incidence of dysphagia and the severity of dysphagia after anterior cervical corpectomy and fusion,without affecting the postoperative bone graft fusion.
出处
《医药论坛杂志》
2018年第1期3-6,共4页
Journal of Medical Forum
基金
河南省科技创新人才计划资助项目(154200510027)
