颈椎矢状位参数与椎前软组织肿胀程度对颈椎前路术后吞咽困难的预测价值

doi:10.3969/j.issn.1006-5725.2026.14.013

Abstract

Abstract:

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.

Key words: cervical sagittal parameters, prevertebral soft tissue swelling, anterior cervical spine surgery, dysphagia, predictive value

CLC Number:

R744.2

Yongbo AN,Ziqiang LU,Zhiqian ZHANG,Qian CHEN,Song LIN,Lei LI. Predictive value of cervical sagittal parameters and prevertebral soft tissue swelling for dysphagia after anterior cervical spine surgery[J]. The Journal of Practical Medicine, 2026, 42(14): 2603-2612.

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项目	发生组（n = 127）	未发生组（n = 135）	Z/χ²/t值	P值
年龄（x ± s）/岁	50.32 ± 7.28	48.39 ± 7.28	2.144	0.033
性别			4.782	0.029
男	61（48.03）	83（61.48）
女	66（51.97）	52（38.52）
体质量指数（x ± s）/（kg/m²）	21.47 ± 4.21	20.98 ± 4.06	0.959	0.338
文化程度			0.073	0.964
初中及以下	35（27.56）	36（26.67）
高中或中专	59（46.46）	62（45.93）
大专及以上	33（25.98）	37（27.40）
吸烟史	61（48.03）	50（37.04）	3.239	0.072
饮酒史	91（71.65）	94（69.63）	0.129	0.719
高血压史	27（21.26）	25（18.52）	0.309	0.578
糖尿病史	25（19.69）	21（15.56）	0.771	0.380
高脂血症	21（16.54）	18（13.33）	0.530	0.467
心血管疾病	14（11.02）	9（6.67）	1.551	0.213
病程			5.302	0.021
≤ 12个月	63（49.61）	86（63.70）
> 12个月	64（50.39）	49（36.30）
手术时间			4.239	0.039
< 2 h	78（61.42）	99（73.33）
≥ 2 h	49（38.58）	36（26.67）
手术入路方向			0.110	0.740
左侧	27（21.26）	31（22.96）
右侧	100（78.74）	104（77.04）
术中出血量			0.068	0.794
< 150 mL	46（36.22）	51（37.78）
≥ 150 mL	81（63.78）	84（62.22）
手术方式			1.847	0.174
颈椎前路椎间盘切除融合术	100（78.74）	115（85.19）
颈椎前路椎体次全切除融合术	27（21.26）	20（14.81）
内固定器材质			0.168	0.682
钢板 + 植骨	57（44.88）	64（47.41）
钢板 + 融合器	70（55.12）	71（52.59）
手术部位			1.193	0.755
C4-5	60（47.24）	67（49.63）
C5-6	35（27.56）	36（26.67）
C6-7	17（13.39）	21（15.56）
C3-4	15（11.81）	11（8.15）
手术节段数			0.737	0.391
单节段	89（70.08）	101（74.81）
多节段	38（29.92）	34（25.19）
颈椎病类型			0.067	0.796
神经根型	61（48.03）	67（49.63）
脊髓型	66（51.97）	68（50.37）

项目	发生组（n = 127）	未发生组（n = 135）	Z/χ²/t值	P值
RBC/（× 10¹²·L ^-¹）	4.52 ± 0.58	4.61 ± 0.62	1.212	0.227
Hb/（g/L）	132.56 ± 15.32	135.28 ± 14.87	1.458	0.146
WBC/（× 10⁹·L ^-¹）	7.85 ± 2.13	7.52 ± 1.98	1.300	0.195
NLR［M（Q₁，Q₃）］	2.28（1.79，2.89）	2.05（1.58，2.62）	2.081	0.038
PLT/（× 10⁹·L ^-¹）	235.68 ± 52.36	241.35 ± 48.72	0.908	0.365
ALT/（U/L）	35.26 ± 10.15	34.18 ± 11.12	0.819	0.413
AST/（U/L）	32.58 ± 10.36	31.85 ± 10.21	0.574	0.566
ALB/（g/L）	38.65 ± 4.23	39.52 ± 3.87	1.738	0.083
PT/s	12.56 ± 1.32	12.42 ± 1.25	0.882	0.379
TBIL/（μmol/L）	15.23 ± 4.68	14.85 ± 4.21	0.692	0.490
TIS/°	23.50 ± 4.44	25.79 ± 3.97	4.408	<0.001
C2-7 SVA/cm	1.95 ± 0.43	1.70 ± 0.34	5.168	<0.001
TIA/°	71.19 ± 11.60	75.75 ± 12.59	3.046	0.003
NT/°	44.81 ± 8.74	47.60 ± 7.71	2.746	0.006
椎前软组织肿胀程度/mm	10.12 ± 2.78	8.45 ± 2.20	5.394	<0.001

因素	赋值
因变量
是否发生吞咽困难	否 = 0，是 = 1
自变量
年龄	实际值
性别	男 = 0，女 = 1
病程	≤ 12月 = 0，> 12月 = 1
手术时间	< 2 h = 0，≥ 2 h = 1
NLR	实际值
TIS	实际值
C2-7 SVA	实际值
TIA	实际值
NT	实际值
椎前软组织肿胀程度	实际值

因素	β	SE	Wald χ²	P值	OR	95%CI
年龄	0.037	0.017	4.480	0.034	1.037	1.003 ~ 1.073
性别	0.546	0.251	4.752	0.029	1.727	1.057 ~ 2.823
病程	0.578	0.252	5.263	0.022	1.783	1.088 ~ 2.922
手术时间	0.547	0.267	4.203	0.040	1.728	1.024 ~ 2.914
NLR	0.336	0.163	4.230	0.040	1.399	1.016 ~ 1.927
TIS	-0.130	0.031	17.114	< 0.001	0.878	0.826 ~ 0.934
C2-7 SVA	1.676	0.355	22.308	< 0.001	5.342	2.665 ~ 10.708
TIA	-0.031	0.011	8.727	0.003	0.969	0.949 ~ 0.990
NT	-0.042	0.016	7.175	0.007	0.959	0.931 ~ 0.989
椎前软组织肿胀程度	0.269	0.055	23.881	<0.001	1.309	1.175 ~ 1.458

因素	β	SE	Wald χ²	P值	OR	95%CI
年龄	0.039	0.021	3.546	0.060	1.040	0.998 ~ 1.083
手术时间	0.220	0.540	0.167	0.683	1.247	0.433 ~ 3.591
NLR	0.276	0.193	2.045	0.153	1.317	0.903 ~ 1.922
TIS	-0.158	0.038	16.877	< 0.001	0.854	0.792 ~ 0.921
C2-7 SVA	1.329	0.415	10.269	0.001	3.778	1.676 ~ 8.518
TIA	-0.045	0.013	11.665	< 0.001	0.956	0.932 ~ 0.981
NT	-0.038	0.019	3.971	0.046	0.963	0.928 ~ 0.999
椎前软组织肿胀程度	0.246	0.062	15.924	<0.001	1.279	1.134 ~ 1.444

Predictive value of cervical sagittal parameters and prevertebral soft tissue swelling for dysphagia after anterior cervical spine surgery

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指标	AUC	标准误	95%CI	P值	Cut-off	约登指数	敏感度/%	特异度/%
TIS	0.654^*	0.034	0.593 ~ 0.711	< 0.001	23.89°	0.264	57.48	68.89
C2-7 SVA	0.679^*	0.033	0.619 ~ 0.735	< 0.001	2.07 cm	0.292	43.31	85.93
TIA	0.604^*	0.035	0.542 ~ 0.664	0.003	80.75°	0.187	78.74	40.00
NT	0.590^*	0.035	0.527 ~ 0.650	0.011	40.29°	0.198	33.86	85.93
椎前软组织肿胀程度	0.689^*	0.033	0.629 ~ 0.744	< 0.001	9.54 mm	0.293	56.69	72.59
联合	0.852	0.024	0.803 ~ 0.893	< 0.001	-	0.594	77.17	82.22

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