文章简介

出版社: The Spine Journal

作   者:Andrei F. Joaquim , Jozef Murar, Jason W. Savage, Alpesh A. Patel

编   号:

年   份:2014    点击量:607

文章摘要 全文翻译

BACKGROUND CONTEXT:

        Anterior cervical spine surgery is one of the most common spinal procedures performed around the world, but dysphagia is a frequent postoperative complication. Many factors have been associated with an increased risk of swallowing difficulties, including multilevel surgery, revision surgery, and female gender.

背景:
        颈椎前路手术是全球最常见的脊柱手术之一,而吞咽困难是该手术常见的一种术后并发症。增加吞咽困难风险的因素很多,包括多节段手术、翻修手术和女性。  


PURPOSE:

        The objective of this study was to review and define potential preventative measures that can decrease the incidence of dysphagia after anterior cervical spine surgery.

目的
        此项研究旨在回顾和确定潜在的预防措施,以便降低颈椎前路手术后吞咽困难的发生率。    


STUDY DESIGN:

        This was a systematic literature review.
研究设计:

        系统性文献回顾。

 

METHODS:

        A systematic review in the Medline database was performed. Articles related to dysphagia after anterior cervical spine surgery and potential preventative measures were included.

方法:
        本文MEDLINE数据库进行了系统性回顾,涵盖了颈椎前路手术后吞咽困难及其潜在预防措施的文章。


RESULTS: 
        Twenty articles met all inclusion and exclusion criteria. These articles reported several potential preventative measures to avoid postoperative dysphagia. Preoperative measures include performing tracheal exercises before the surgical procedure. Intraoperative measures can be summarized as avoiding a prolonged operative time and the use of recombinant human bone morphogenetic protein in routine anterior cervical spine surgery, using small and smoother cervical plates, using anchored spacers instead of plates, application of steroid before wound closure, performing arthroplasty instead of anterior cervical fusion for one-level disease, decreasing tracheal cuff pressure during medial retraction, using specific retractors, and changing the dissection plan.
结果:
        二十篇文章符合纳入和排除标准。这些文章报告了避免术后吞咽困难的潜在预防措施。术前措施包括在外科手术前进行气管相关锻炼。术中措施可概括为常规颈椎前路手术中避免手术时间延长且不使用重组人骨形态发生蛋白,使用小而光滑的颈椎钢板,以锚式间隔替代钢板,闭合伤口前应用类固醇,以关节置换术替代颈椎前路融合术治疗单节段疾病,向内牵拉过程中降低气管套囊压力,使用特殊牵引器,以及更改切骨方案。
 

CONCLUSIONS:

        Current literature supports several preventative measures that may decrease the incidence of postoperative dysphagia. Although the evidence is limited and weak, most of these measures did not appear to increase other complications and can be easily incorporated into a surgical practice, especially in patients who are at high risk for postoperative dysphagia.

结论:
        现有文献认为联合多种预防措施可降低术后吞咽困难的发生率。尽管证据有限且不充分,但是绝大多数措施没有引起其他并发症,并且易于应用到手术实践中,尤其是术后吞咽困难风险较高的患者。