颈椎管成形术与椎板切除内固定术后C5神经根麻痹比较  

Comparison of incidence of Cs nerve palsy after laminoplasty and laminectomy with internal fixation

作　　者：李君[1] 王新伟[1] 袁文[1] 陈德玉[1] 陈宇[1] 梁磊[1] 王占超[1] 姜东杰[1] 

机构地区：[1]第二军医大学附属长征医院骨科,上海200003

出　　处：《中华骨科杂志》2012年第5期415-419,共5页Chinese Journal of Orthopaedics

摘　　要：目的比较颈后路单开门椎管成形术与椎板切除内固定术治疗多节段脊髓型颈椎病术后颈5（C5）神经根麻痹的发生率，并分析其原因。方法2005年1月至2010年6月，因多节段颈脊髓病变分别接受椎管成形术的患者27例（A组）：男21例，女6例；年龄33-80岁，平均60．4岁；减压3《个节段。同期接受椎板切除内固定术的患者41例（B组）：男31例，女10例；年龄22-77岁，平均58．7岁；减压3-6个节段。术后随访12-46个月（平均22个月）；两组手术前后以Cobb法测量颈椎前凸角度，以Ishihara法测定颈椎曲度指数（cervicalcurvatureindex，CO），并记录术后C5神经根麻痹的发生情况。比较B组中9例C5神经根麻痹患者（B1组）与32例无C，神经根麻痹患者（B2组）的手术前后颈椎前凸角度及CCI。结果A组C5神经麻痹发生率为3．7％（1／27），B组发生率为22．0％（9／41），差异有统计学意义（x^2=4．32，P〈0．05），10例C5神经根麻痹患者平均于术后14个月肌力恢复至4级以上。B1组手术前后CCI改变率为38．07％-18．03％，B2组为22．81％±12．71％，两组差异有统计学意义（t=2．88，P〈0．05）。结论相比颈后路椎板切除内固定术，椎管成形术后C5神经根麻痹发生率低。C5神经根麻痹可能与颈后路术后颈椎前凸增加有关，神经根拴系效应是其重要的发病机制之一。Objective To compare the incidence of C5 nerve palsy after laminoplasty and laminectomy with internal fixation for treating multilevel cervical spondylotic myelopathy （MCSM）. Methods From January 2005 to June 2010, 68 patients with MCSM were treated with laminoplasty （27 patients, group A） or laminectomy with internal fixation （41 patients, group B）. There were 21 males and 6 females in group A, aged 33-80 years （average, 60.4 years）, 31 males and 10 females in group B, aged 22-77 years （average, 58.7 years）. All the patients were followed up for 12-48 months （average, 22 months）. In both groups, Cobb＇s method was applied to measure cervical lordotic angle, and Ishihara＇s method was conducted to measure cervical curvature index （CCI） before and after operation. The incidence of C5 nerve palsy was recorded and compared. Then we further compared preoperative and postoperative the cervical lordosis angle and CCI of 9 patients with C5 nerve palsy （group B1） and 32 patients without C5 nerve palsy （group B2） in group B. Resuits The incidence of Cs nerve palsy in group A was 3.7%（1/27）, while 22.0%（9/41） in group B （X2=4.32, P〈0.05）. For all ten patients with C5 nerve palsy, the muscle strengths of paralyzed muscles were recovered to grade 4 or better after being treated with conservative treatment for an average of 14 months. The change rate of preoperative and postoperative CCI in group B1 was 38.07%±18.03%, while 22.81%±12.71% in group B2. There was a statistical difference between group B1 and group B2 （t=2.88, P〈0.05）. Conclusion Compared with laminoplasty, laminectomy with internal fixation has a higher incidence of C5 nerve palsy. The C5 nerve palsy may be associated with postoperative increase of cervical lordosis angle. Moreover, tethering of the C5 root may be one of its important pathomechanisms.

关 键 词：颈椎病 椎板切除术 神经根病 

分 类 号：R687.3[医药卫生—骨科学]