颈椎单开门椎管扩大椎板成形术后铰链侧C_5神经根麻痹与不同椎板开门角度的临床分析  

CLINICAL ANALYSIS OF C_5 NERVE ROOT PALSY IN HINGE SIDE AND DIFFERENT ANGLES IN LAMINA OPEN-DOOR AFTER EXPANSION OF OPEN-DOOR CERVICAL LAMINOPLASTY

作　　者：孙天威[1] 张杭[2] 卢守亮[2] 李辉南[1] 于斌[1] 张学利[1] 

机构地区：[1]天津市人民医院脊柱外科,天津300121 [2]天津医科大学研究生院

出　　处：《中国修复重建外科杂志》2011年第11期1285-1289,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的评价颈后路单开门颈椎管扩大椎板成形术中不同椎板开门角度与术后临床疗效、铰链侧C5神经根麻痹以及再关门的关系。方法回顾性分析2006年7月-2009年1月,采用颈后路单开门椎管扩大椎板成形术治疗的198例脊髓型颈椎病患者临床资料。通过术后CT测量,按照椎板开门变化角度,以30°为界限将患者分为两组:A组76例为椎板开门变化角度>30°者,其中男44例,女32例;B组122例为椎板开门变化角度15～30°者,其中男71例,女51例;两组患者性别、年龄、病程、病变节段等一般资料比较差异均无统计学意义(P>0.05)。采用日本骨科协会(JOA)评分法评定手术前后患者神经功能及改善率,并记录术后出现C5神经根麻痹及再关门患者的情况。结果两组患者手术时间、出血量及住院时间比较差异无统计学意义(P>0.05)。术后3周内A组7例(9.2%)、B组2例(1.6%)铰链侧发生C5神经根麻痹,均经对症治疗后恢复;两组C5神经根麻痹发生率比较差异有统计学意义(χ2=4.568,P=0.033)。术后患者均获随访,随访时间24～48个月。术后24个月A、B组JOA改善率比较差异无统计学意义(P>0.05);术前及术后24个月两组间JOA评分差异均无统计学意义(P>0.05),且同一组内术后24个月较术前明显改善(P<0.05)。术后24个月,9例C5神经根麻痹患者患肢上举功能均恢复;CT检查示A组患者无再关门发生,B组患者4例(3.3%)发生再关门,但随访期间症状无反复或加重。结论颈椎单开门椎管扩大椎板成形术中不同椎板开门角度临床疗效相似,C5神经根麻痹的预后良好;将椎板开门变化角度控制在15～30°降低了铰链侧C5神经根麻痹的发生率,但应注意开门应固定牢固,防止再关门发生。Objective To evaluate and compare the relation of the clinical results of expansion of open-door cervical laminoplasty（EOLP）,C5 nerve root palsy in hinge side,and reclose of the opened laminae with different angles in lamina open-door.Methods Between July 2006 and January 2009,198 patients with cervical myelopathy were treated by EOLP.According to different opening angles which were measured by CT scan after operation,the patients were divided into group A（ 30°,76 patients including 44 males and 32 females） and group B（15-30°,122 patients including 71 males and 51 females）.There was no significant difference in gender,age,disease duration,and segmental lesions between 2 groups（P 0.05）.The Japanese Orthopaedic Association（JOA） score before and after operation was used for neurological assessment and improvement rate,and the postoperative C5 nerve root palsy and reclose of the opened laminae were recorded.Results There was no significant difference in operation time,bleeding volume,and hospitalization days between 2 groups（P 0.05）.After 3 weeks of operation,C5 nerve root palsy in the hinge side occurred in 7 patients（9.2%） of group A,and in 2 patients（1.6%） of group B,were restored after symptomatic treatment,showing significant difference between 2 groups（χ2= 4.568,P= 0.033）.All patients were followed up 24 to 48 months.Between group A and group B,no significant difference was found in JOA improvement rate at 24 months after operation（P 0.05）,and in JOA score at preoperation and at 24 months after operation（P 0.05）,but JOA score was significantly improved at 24 months after operation when compared with preoperative score in the same group（P 0.05）.The function of limb lifting restored in 9 cases of C5 nerve root palsy at 24 months after operation;CT examination revealed that no reclose occured in group A and reclose occurred in 4 cases（3.3%） of group B,but no persistent symptoms or worsen situation were found during follow-up.Conclusion Different angles in lami

关 键 词：脊髓型颈椎病 单开门颈椎管扩大椎板成形术 椎板开门角度 C5神经根麻痹 再关门 

分 类 号：R687.3[医药卫生—骨科学]