颈椎前路手术术中应用可吸收胶原生物膜对术后吞咽功能改善的影响

目的探索可吸收胶原生物膜对颈椎前路术后吞咽困难功能的影响，改进手术细节，提高患者术后生活质量。方法采用前瞻性的对照研究方法，自2016年3月始，将于华西医院骨科住院拟行颈椎前路连续双节段椎间融合（Zero-P假体）的患者分为实验组和对照组，每组入选20例，对照组在植入颈椎假体后常规缝合椎前筋膜；实验组在常规缝合椎前筋膜的基础上于椎前软组织间隙放置可吸收胶原生物膜。术后3天、3月、6月于颈椎侧位X线片上测量手术节段椎前软组织（PST）厚度以判断椎前软组织肿胀情况，并完善Bazaz 吞咽困难评价标准和吞咽-生活质量（SWAL-QOL）问卷调查以评估吞咽功能。结果术后3天实验组与对照组PST肿胀分别为（0.59±0.38）cm和（0.63±0.3）cm，差异无统计学意义（P＞0.05），术后3个月、6个月实验组与对照组PST肿胀分别为（0.19±0.12）cm和（0.43±0.35）cm、（0.2±0.12）cm和（0.4±0.31）cm，差异均有统计学意义（P＜0.05）。术后3天、6个月实验组与对照组SWAL-QOL问卷评分分别为62.05±1.57和61.26±1.48、68.75±1.33和68.05±1.47，无明显统计学差异（P＞0.05），而术后3个月实验组与对照组SWAL-QOL问卷评分分别为65.9±1.41和63.47±1.35，差异具有统计学意义（P＜0.05）。术后3天、6个月实验组与对照组吞咽困难总体发生率分别为35%和57.89%、10%和21.05%，差异无明显统计学意义P＞0.05），而术后3个月实验组与对照组吞咽困难总体发生率分别为15%和47.36%，差异具有明显统计学差异（P＜0.05）。结论术中应用可吸收胶原生物膜能够在ACSS术后早期降低吞咽困难总体发生率，在极早期可以预防中度及以上吞咽困难的发生。

英文摘要:

Objective To investigate the change of swallowing function after using absorbable collagen bio-membrane during the anterior cervical spine surgery (ACSS) for improving the detail of surgery and the quality of life after surgery. Methods A prospective controlled study was made to select the data of patients who underwent double-level anterior cervical decompression and fusion with Zero-P implant in West China Hospital after March 2016. The patients were divided into experimental group and control group with 20 cases for each one. The absorbable collagen bio-membrane was used after suturing the prevertebral fascia on the experimental group, however the control group was sutured the prevertebral fascia only. The thickness of prevertebral soft tissue (PST) was measured on the lateral X-ray to determine the extent of swelling at 3 days, 3 and 6 months postoperatively. Also, the Bazaz grading system and the Swallowing-Quality of Life (SWAL-QOL) survey was used to assess the swallowing function at each time. Results The extent of PST swelling of experimental group and control group was (0.59±0.38) cm and (0.63±0.3) cm at 3 days with no significant difference(P>0.05). However, the one of experimental group and control group at 3 and 6 months was (0.19±0.12) cm and (0.43±0.35) cm, (0.2±0.12) cm and (0.4±0.31) cm with significant difference for both (P<0.05). The SWAL-QOL survey of experimental group and control group at 3 days and 6 months was 62.05±1.57 and 61.26±1.48, 68.75±1.33 and 68.05±1.47 with no significant difference for both (P>0.05), but the one of experimental group and control group at 3 months was 65.9±1.41 and 63.47±1.35 with significant difference (P<0.05). The total incidence of dysphagia in experimental group and control group at 3 days and 6 months was 35% and 57.89%, 10% and 21.05% with no significant difference (P>0.05), but the incidence of experimental group and control group at 3 months was 15% and 47.36% with significant difference (P<0.05). Conclusion The application of absorbable collagen bio-membrane in the anterior cervical spine surgery can reduce the total incidence of dysphagia at early time after surgery and prevent the moderate and severe dysphagia at the very early time after surgery.

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