颈后路单开门椎管成形术联合椎间孔切开对预防术后C_5神经根瘫的影响  

INFLUENCE OF CERVICAL SINGLE OPEN-DOOR LAMINOPLASTY WITH UNILATERAL C_(4,5) FORAMINOTOMY ON C_5 PALSY

作　　者：孟德福[1,2] 孙天威[2] 田融[2] 张学利[2] 胡炜[2] 贾宇涛[2] 

机构地区：[1]天津医科大学研究生院,天津300070 [2]天津市人民医院脊柱外科

出　　处：《中国修复重建外科杂志》2014年第4期463-467,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的 探讨颈后路单开门椎管成形术联合单侧C4、5椎间孔切开术对预防术后C5神经根瘫的临床疗效。方法 回顾分析2008年1月-2012年6月收治的200例符合选择标准的脊髓型颈椎病合并单侧C4、5椎间孔狭窄患者临床资料,其中行颈后路单开门椎管成形术联合单侧C4、5椎间孔切开术89例（A组）,单纯行颈后路单开门椎管成形术111例（B组）。两组患者年龄、性别、病程、病变节段及诊断分布比较,差异均无统计学意义（P〉0.05）,具有可比性。记录两组患者手术时间、术中出血量、C5神经根瘫发生率;手术前后采用日本骨科协会（JOA）评分法进行神经功能评分,并计算JOA改善率。结果 A组手术时间和术中出血量分别为（122±29）min和（165±50）mL,均显著高于B组的（109±31）min和（145±32）mL（t=3.033,P=0.010;t=3.429,P=0.003）。两组患者均获随访,A组随访时间3～48个月,平均25个月;B组4～50个月,平均27个月。A、B组分别有1例（1.12%）和9例（8.11%）发生C5神经根瘫,发生率比较差异有统计学意义（χ2=3.709,P=0.045）。两组术后2周及末次随访时JOA评分均较术前显著改善（P〈0.05）;术后2个时间点间差异无统计学意义（P〉0.05）。两组间各时间点JOA评分及末次随访时JOA改善率比较,差异均无统计学意义（P〉0.05）。随访期间两组患者均无长期持续轴性疼痛,无明显脊柱不稳。结论 颈后路单开门椎管成形术联合单侧C4、5椎间孔切开术治疗脊髓型颈椎病合并单侧C4、5椎间孔狭窄,可降低术后C5神经根瘫发生率。Objective To evaluate the effectiveness of cervical single open-door C4, 5 foraminotomy for cervical myelopathy in preventing postoperative C5 palsy. Methods laminoplasty with the unilateral Between January 2008 and June 2012, 200 consecutive patients with cervical myelopathy and unilateral C4,5 foraminal stenosis were treated, and the clinical data were retrospectively analyzed. Of them, 89 patients underwent cervical single open-door laminoplasty combined with unilateral C4,5 foraminotomy （group A）, and 111 patients underwent simple cervical single open-door laminoplasty （group B）. There was no significant difference in gender, age, disease duration, segmental lesions, and diagnosis distribution between 2 groups （P 〉 0.05）. The operation time, intraoperative bleeding volume, and the incidence of C5 palsy were recorded. The Japanese Orthopaedic Association （JOA） score before and after operation was used for neurological assessment, and the ]OA recovery rate was calculated. Results The operation time was （122 ± 29） minutes and the intraoperative bleeding volume was （165 ±50） mL in group A, which were significantly higher than those in group B [（109 ± 31） minutes and （145 ± 32） mL] （t=3.033, P=0.010; t=-3.429, P=0.003）. All patients were followed up; the follow-up time was 3-48 months （mean, 25 months） in group A, and was 4-50 months （mean, 27 months） in group B. Cs palsy occurred in 1 patient of group A （1.12%）, and in 9 patients of group B （8.11%）, showing significant difference between 2 groups （Z2=3.709, P=0.045）. The ]OA score was significantly improved at 2 weeks and last follow-up after operation when compared with preoperative JOA scores in 2 groups （P 〈 0.05）, but no significant was found between at 2 weeks and at last follow-up （P 〉 0.05） in eachgroup. Between group A and group B, no significant difference was found in JOA score and the recovery rate （P 〉 0.05）. During follow-up, no persistent axial pain for a long time and

关 键 词：5神经根瘫 颈后路单开门椎管成形术 椎间孔切开术 脊髓型颈椎病 

分 类 号：R687.3[医药卫生—骨科学]