Research On The Related Factors Of Dysphagia After Using Transoral Atlantoaxial Reduction Plate System To Treat Basilar Invagination

Objective:The main purpose of this study is to1)find out the risk factors of TARP which use to treat Basilar Invagination may lead to dysphagia and its correlation,especially the changes of OC2 angle C2-C7 angle and the nPAS;2)give a more reasonable explanation for the patients who underwent TARP treatment why they develop postoperative dysphagia;3)give the idea of how to avoid dysphagia after TARP.Method:1.In this study,we collected 110 consecutive cases of basilar invagination treated by TARP operation in our department between January 2013 and December 2017.According to strict inclusion criteria and exclusion criteria,81 patients were eventually included.2.The symptoms,sex,age,operation time and amount of bleeding in all patients were collected through the record of medical records.The O-C2 angle,postoperative O C2 angle,dO C2 angle,preoperative C2-C7 angle,postoperative C2-C7 angle,dC2-C7 angle,preoperative nPAS,postoperative C2-C7,total compensation angle and so on were collected and measured by PACs system.3,We use the Student s T test for two groups of age,bleeding volume,operation time,preoperative and postoperative O angle C2 O C2 dO angle,C2 angle,C2-C7 angle of preoperative and postoperative C2-C7 angle,dC2-C7 angle,preoperative nPAS,nPAS,dnPAS,the offset angle were statistically test.Chi square test was used to determine whether there was a difference in gender composition between the two groups.Spearman correlation coefficient was used to assess whether there is a correlation between dO-C2A and nPAS,between dO-C2A and dC2-C7,and between dO-C2A and OA.It is also used to determine whether there is a linear relationship between risk factors and the grade of dysphagia.Logistic regression analysis was used to analyze whether dO-C2 angle,dC2-C7 angle,OA,operative time,operative bleeding volume,gender,age and other factors were risk factors for dysphagia.The standard of statistical significance was defined as p<0.05.All statistical analyses were performed using SPSS 17(SPSS,Inc.,Chicago,IL,USA).Results:Through statistical analysis,we found that there were significant differences in O-C2 angle(p=0.049),dO-C2A(p=0.029),postoperative nPAS(p=0.027),dnPAS(p=0.017)and offset angle(p=0.004)between the two groups of A and B.Through Logistic regression analysis,we found dO-C2 angle(P = 0.020)and the offset angle(P = 0.025)increase is the main risk factors of postoperative dysphagia.Through linear regression analysis between dO-C2 angle and offset angle,found there was a strong evidence(P = 0.001),but the correlation was not strong enough(P = 0.374).Conclusion:This study found that the dO-C2 angle plays an important role in the development of dysphagia after TARP.The postoperative dysphagia may occur due to the direct reduction results,may also be due to excessive increase when the cervical sequence cannot be completely compensated,which caused the increase of OA,so we recommend during TARP surgery,surgeon should be more positive in measurement of O-C2 angle,try to avoid the excessive increase of O-C2 angle.So the OA after operation could maintained in the neutral position,this helps to reduce the probability of development of postoperative dysphagia.