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  • Title: [Research on effectiveness of occipito-odontoid angle in predicting dysphagia after occipitocervical fusion in patients with C 2, 3 Klippel-Feil syndrome].
    Author: Zou Q, Wang L, Yang X, Chen T, Hu B, Liu L, Song Y.
    Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2022 Jun 15; 36(6):739-744. PubMed ID: 35712932.
    Abstract:
    OBJECTIVE: To introduce a new occipitocervical angle parameter, occipito-odontoid angle (O-Da), for predicting dysphagia after occipitocervical fusion (OCF) in patients with C 2, 3 Klippel-Feil syndrome (KFS) and analyze its effectiveness. METHODS: A total of 119 patients met selective criteria between April 2010 and November 2019 were retrospectively included as the study subjects. There were 56 males and 63 females. The age ranged from 14 to 76 years, with a median age of 51 years. There were 44 cases of basilar invagination and 75 cases of atlantoaxial subluxation. Forty patients were combined with C 2, 3 KFS. Seven patients underwent anterior decompression combined with posterior OCF and 112 patients underwent posterior OCF. The fixed segments were O-C 2 in 36 cases, O-C 3 in 51 cases, O-C 4 in 25 cases, and O-C 5 in 7 cases. All patients were followed up 21-136 months, with a median time of 79 months. The lateral cervical X-ray films before operation and at last follow-up were used to measure the occipital to C 2 angle (O-C 2a), the occipital and external acoustic meatus to axis angle (O-EAa), the occipital protuberance to axial angle (Oc-Axa), the O-Da, and the narrowest oropharyngeal airway space (nPAS). The differences of the above parameters between the last follow-up and the preoperative values were calculated (represented as dO-C 2a, dO-EAa, dOc-Axa, dO-Da, and dnPAS). Patients were divided into two groups according to whether they suffered dysphagia after operation, and the differences in clinical data and radiographic parameters were compared between the two groups. The correlation between occipitocervical angle parameters and nPAS in 40 patients with C 2, 3 KFS was analyzed respectively. In addition, sensitivity and specificity analyses were used to assess the effectiveness of dO-Da≤-5° for the prediction of postoperative dysphagia. RESULTS: Thirty-one patients (26.1%) suffered dysphagia after OCF (dysphagia group), including 10 patients with C 2, 3 KFS; no dysphagia occurred in 88 patients (non-dysphagia group). There was no significant difference in age, follow-up time, fixed segment, proportion of patients with rheumatoid arthritis, proportion of patients with atlantoaxial subluxation, and proportion of patients with C 2, 3 KFS between the two groups ( P>0.05). The proportion of female patients was significantly higher in dysphagia group than in non-dysphagia group ( χ 2=7.600, P=0.006). The difference in preoperative O-C 2a between the two groups was significant ( t=2.528, P=0.014). No significant differences were observed in preoperative O-EAa, Oc-Axa, O-Da, and nPAS ( P>0.05). There was no significant difference in dO-C 2a, dO-EAa, dOc-Axa, dO-Da, and dnPAS between the two groups ( P>0.05). The dO-C 2a, dO-EAa, dOc-Axa, and dO-Da were positively correlated with dnPAS in 40 patients with C 2, 3 KFS ( r=0.604, P<0.001; r=0.649, P<0.001; r=0.615, P<0.001; r=0.672, P<0.001). Taking dO-Da≤-5° as the standard, the sensitivity and specificity of dO-Da to predict postoperative dysphagia in patients with C 2, 3 KFS were 80.0% (8/10) and 93.3% (28/30), respectively. CONCLUSION: The dO-Da is a reliable indicator for predicting dysphagia after OCF in patients with C 2, 3 KFS. 目的: 介绍一个新的枕颈角度参数——枕骨-齿突角（occipito-odontoid angle，O-D角），分析其预测C 2、3 Klippel-Feil（KF）综合征患者枕颈融合术后吞咽困难发生的有效性。. 方法: 以2010年4月—2019年11月符合选择标准的119例患者作为研究对象。其中，男 56 例，女 63例；年龄 14～76 岁，中位年龄51岁。颅底凹陷44例，寰枢椎脱位75例；其中40例合并C 2、3 KF综合征。7 例行前路减压联合后路枕颈融合术，112例行单纯后路枕颈融合术。手术固定节段：O～C 2 36 例、 O～C 3 51 例、O～C 4 25 例、O～C 5 7 例。术后随访时间 21～136个月，中位时间 79 个月。于术前及末次随访时颈椎侧位X线片，测量枕骨- C 2角（occipital to C 2 angle，O-C 2角）、枕骨-外耳道枢椎角（occipital and external acoustic meatus to axis angle，O-EA角）、枕外隆突-齿突角（occipital protuberance to axial angle，Oc-Ax角）、O-D角和最狭窄口咽气道直径（the narrowest oropharyngeal airway space，nPAS），计算上述参数末次随访时与术前差值（记为dO-C 2角、dO-EA角、dOc-Ax角、dO-D角、dnPAS）。根据患者术后是否发生吞咽困难，分为吞咽困难组和无吞咽困难组，比较两组临床资料以及上述参数差异；分析40例合并C 2、3 KF综合征患者的枕颈角度参数与nPAS相关性，以dO-D角≤−5° 作为标准，评价其预测枕颈融合术后吞咽困难发生的灵敏度和特异度。. 结果: 枕颈融合术后31例（26.1%）患者发生吞咽困难（吞咽困难组），其中10例为C 2、3 KF综合征者；88例未发生该并发症（无吞咽困难组）。两组患者年龄、随访时间、固定节段、类风湿性关节炎构成比、寰枢椎脱位构成比、合并C 2、3 KF综合征构成比比较，差异均无统计学意义（ P>0.05）；吞咽困难组女性患者构成比高于无吞咽困难组（ χ 2=7.600， P=0.006）。两组术前O-C 2角差异有统计学意义（ t=2.528， P=0.014），O-EA角、Oc-Ax角、O-D角、nPAS差异无统计学意义（ P>0.05）；dO-C 2角、dO-EA角、dOc-Ax角、dO-D角和dnPAS比较，差异均有统计学意义（ P<0.05）。40例合并C 2、3 KF综合征患者的dO-C 2角、dO-EA角、dOc-Ax角、dO-D角均与dnPAS成正相关（ r=0.604， P<0.001； r=0.649， P<0.001； r=0.615， P<0.001； r=0.672， P<0.001）。以dO-D角≤−5° 为标准，预测合并C 2、3 KF综合征患者术后吞咽困难发生的灵敏度和特异度分别为80.0%（8/10）和93.3%（28/30）。. 结论: dO-D角可以预测C 2、3 KF综合征患者枕颈融合术后吞咽困难发生。.
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