多节段前路减压手术治疗脊髓型颈椎病后的长期吞咽困难：III期CSM-Protect试验结果
Long-term dysphagia after multilevel anterior decompressive surgery for cervical myelopathy: findings from the phase III CSM-Protect trial.
文献信息
| PMID | 42854252 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Alex B Bak |
| 作者单位 | 1Department of Anesthesiology and Pain Medicine, University of Toronto. |
| 期刊 | Journal of neurosurgery. Spine |
| SCI 分区 | Q1 |
| IF | 3.7 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
目的： 吞咽困难是颈椎前路手术后常见的早期并发症，但其长期自然史和危险因素仍不完全清楚，尤其是在治疗退变性脊髓型颈椎病（DCM）的多节段手术中。本研究旨在描述术后吞咽困难的自然史，并确定12个月时持续性吞咽困难的预测因素。
方法： 回顾性分析2012年至2017年间因DCM接受前路减压并作为CSM-Protect试验一部分前瞻性入组的成年患者。在基线以及术后35、180和365天使用Bazaz量表（无、轻度、中度或重度）评估吞咽困难的存在和严重程度。使用控制研究随机化和中心的多变量逻辑回归来确定365天时吞咽困难的危险因素。
结果： 在总共290名患者中，132名受试者符合纳入标准。术前，11.4%的患者有中度吞咽困难。吞咽困难在35天时达到高峰，占所有患者的68.6%（14%为重度），随后在180天时降至47%，在365天时降至36.4%。1年时，10.6%有中度吞咽困难，3.0%为重度。多变量分析显示，C5水平的前路手术（OR 4.52，95% CI 1.16-19.4，p = 0.034）、基线吞咽困难（OR 4.56，95% CI 1.74-12.9，p = 0.003）和脊髓病症状持续时间较短（每减少一个月OR 0.98，95% CI 0.97-0.98，p = 0.027）与持续性吞咽困难独立相关。
结论： 在这个以多节段前路颈椎手术为主的队列中，术后吞咽困难早期达到高峰，但在1年时仍很常见。基线吞咽困难、C5水平受累和症状持续时间较短是长期吞咽困难的关键预测因素。
英文摘要
OBJECTIVE: Dysphagia is a common early complication after anterior cervical spine surgery, yet its long-term natural history and risk factors remain incompletely understood, particularly in multilevel procedures for degenerative cervical myelopathy (DCM). This study aimed to characterize the natural history of postoperative dysphagia and identify predictors of persistent dysphagia at 12 months.
METHODS: Adult patients who received anterior decompression for DCM between 2012 and 2017 and were prospectively enrolled as part of the CSM-Protect trial were retrospectively reviewed. Presence and severity of dysphagia were assessed with the Bazaz scale (none, mild, moderate, or severe) at baseline and 35, 180, and 365 days postoperatively. Multivariable logistic regression controlling for study randomization and site were used to identify risk factors for dysphagia at 365 days.
RESULTS: From a total of 290 patients, 132 subjects met the eligibility criteria. Preoperatively, 11.4% of patients had moderate dysphagia. Dysphagia peaked at 35 days with 68.6% of all patients (14% severe) before declining to 47% at 180 days and 36.4% at 365 days. At 1 year, 10.6% had moderate dysphagia and 3.0% severe. Multivariable analysis demonstrated that anterior surgery at the C5 level (OR 4.52, 95% CI 1.16-19.4, p = 0.034), baseline dysphagia (OR 4.56, 95% CI 1.74-12.9, p = 0.003), and shorter duration of myelopathic symptoms (OR 0.98 per month, 95% CI 0.97-0.98, p = 0.027) were independently associated with persistent dysphagia.
CONCLUSIONS: In this cohort of primarily multilevel anterior cervical surgical procedures, postoperative dysphagia peaked early but remained common at 1 year. Baseline dysphagia, C5-level involvement, and shorter symptom duration were key predictors of long-term dysphagia.