目的 探讨颈椎矢状位参数与椎前软组织肿胀程度预测颈椎前路术（ACSS）后吞咽困难的价值。 方法 回顾性选取2021年1月至2023年12月医院收治的拟接受颈椎前路术治疗的262例颈椎病患者的临床资料，所有患者术后密切监测48 h，根据48 h内是否出现吞咽困难分为发生组（n = 127）和未发生组（n = 135）。比较两组临床资料、颈椎矢状位参数与椎前软组织肿胀程度，多因素logistic回归分析颈椎前路术后吞咽困难的影响因素，绘制受试者工作特征（ROC）曲线分析各影响因素预测ACSS术后吞咽困难的价值，并构建列线图模型。 结果 多因素logistic回归结果显示，TIS、TIA、NT是ACSS术后发生吞咽困难的独立保护因素，C2-7 SVA、椎前软组织肿胀程度是ACSS术后发生吞咽困难的独立危险因素（P < 0.05）；TIS、C2-7 SVA、TIA、NT、椎前软组织肿胀程度联合预测ACSS术后吞咽困难价值高于单独预测（Z_TIS-联合 = 5.848、Z_{C2-7 SVA-联合} = 5.384、Z_TIA-联合 = 6.708、Z_NT-联合 = 5.848、Z_{椎前软组织肿胀程度-联合} = 6.643，P < 0.05）。列线图显示，各指标预测价值与实际相仿，训练集和验证集ROC曲线的AUC分别为0.84（0.75 ~ 0.92）、0.83（0.74 ~ 0.92），模型预测价值与实际相仿，且模型阈值在50% ~ 90%间有较高正收益。 结论 颈椎矢状位参数联合椎前软组织肿胀程度对ACSS术后吞咽困难具有良好的预测效能，可为临床筛选高风险人群提供理论依据。

Objective To investigate the value of cervical sagittal parameters and the degree of prevertebral soft tissue swelling in predicting dysphagia following Anterior Cervical Spine Surgery （ACSS）. Methods Clinical data of 262 patients with cervical spondylosis who were scheduled to undergo ACSS at the hospital from January 2021 to December 2023 were retrospectively collected. All patients were closely monitored for 48 hours post-operatively and then assigned to either a dysphagia group （n = 127） or a non-dysphagia group （n = 135） based on the development of dysphagia within 48 hours. The clinical data， cervical sagittal parameters， and the degree of prevertebral soft tissue swelling were compared between the two groups. Multivariable logistic regression analysis was employed to identify the factors associated with dysphagia after ACSS. Receiver Operating Characteristic （ROC） curves were plotted to assess the predictive value of each factor for post-ACSS dysphagia， and a nomogram model was constructed. Results Multivariable logistic regression analysis demonstrated that TIS， TIA， and NT were independent protective factors against dysphagia following ACSS. In contrast， C2-7 SVA and the degree of prevertebral soft tissue swelling were identified as independent risk factors （P < 0.05）. The combined prediction utilizing TIS， C2-7 SVA， TIA， NT， and the degree of prevertebral soft tissue swelling exhibited a higher predictive value compared to any individual parameter （Z_TIS-combined = 5.848， Z_{C2-7 SVA-combined} = 5.384， Z_TIA-combined = 6.708， Z_NT-combined = 5.848， Z_{degree of prevertebral soft tissue swelling-combined} = 6.643， P < 0.05）. The nomogram indicated that the predictive performance of the model was in line with the observed outcomes. The area under the ROC curve （AUC） was 0.84 （0.75 - 0.92） for the training set and 0.83 （0.74 - 0.92） for the validation set， suggesting good predictive performance. Moreover， the model showed a high net benefit across probability thresholds ranging from 50% to 90%. Conclusion Cervical sagittal parameters， when combined with the degree of prevertebral soft tissue swelling， demonstrated good predictive performance for postoperative dysphagia after ACSS and may offer a theoretical basis for the clinical screening of high-risk individuals.