颈椎前路椎间隙减压融合固定致上肢外展上举功能受限的相关因素分析  

An analysis of related factors of the upper extremity abduction and lift limitation after anterior cervical decompression and fusion

作　　者：朱迪[1] 刘宝戈[1] 王磊[1] 朱继超[1] 崔维[1] 曾峥[1] 亢卫波[1] 杨江[1] 

机构地区：[1]首都医科大学附属北京天坛医院骨科,北京100050

出　　处：《中华骨科杂志》2014年第10期992-999,共8页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金资助项目（81171764）

摘　　要：目的：探讨颈椎前路椎间隙减压融合固定致上肢外展上举功能受限的相关因素。方法回顾性分析2012年2月至2013年6月采用颈椎前路椎间隙减压固定融合术治疗117例颈椎病患者，根据术后患者上肢外展上举的情况，将患者分为上肢外展上举受限组与未受限组，记录上肢外展上举受限时上肢三角肌肌力、感觉、恢复时间及恢复时三角肌肌力；比较两组患者术前、术后日本骨科协会（Japanese Orthopaedic Association，JOA）及颈椎功能障碍指数（neck disability in-dex, NDI）评分。比较两组患者术前C4，5节段退变程度，术前、术后C4-5椎间隙高度变化，术前C3～5脊髓高信号情况，术前C3～5后纵韧带骨化情况。结果7例患者术后出现上肢外展上举功能障碍，其中三角肌肌力3级6例，2级1例。7例患者随访8～16个月，末次随访时6例肌力恢复至5级，1例恢复至4级；2例上肢仍残存感觉障碍。7例患者JOA评分由术前（8.9±1.8）分改善至末次随访时（13.8±2.4）分，改善率平均为65%。117例患者中，短节段手术（1～2个节段）上肢外展受限率为1.5%（1/67），长节段手术（＞3个节段）受限率为12%（6/50）。外展上举受限组C4-5间盘退变9分法评分为（2.1±0.37）分，未受限组为（2.6±1.4）分。上肢外展受限组C4-5间隙高度较术前增加（2.1±0.66）mm，无上肢功能障碍组增加（2.2±1.1）mm。7例外展上举受限患者中4例术前MRI T2WI示C3～5存在高信号（57.1%），未受限患者中2例术前C3～5存在高信号（1.8%）。结论颈椎前路椎间隙减压融合固定后出现上肢外展上举受限的发生率较低，预后较好，但合并感觉障碍的患者预后稍差。多节段减压手术及术前MRI T2WI示C3～5脊髓高信号是术后发生上肢外展上举受限的可能相关因素。Objective To investigate the associated factors of upper extremity abduction and lift limitations after anterior cervical decompression and fusion. Methods Data of 117 patients from February 2012 to June 2013 who had undergone anterior cervical decompression and fusion for cervical spondylosis were reviewed retrospectively. The upper extremity abduction and lift situation after operation, the deltoid muscle strength and its sensory were recorded. Japanese Orthopaedic Association （JOA） score and neck disability index （NDI） score were taken to evaluate the spinal cord function before operation and at final follow-up. C4-5 intervertebral height, C4-5 cervical degeneration, high signal in MRI and ossification of posterior longitudinal ligament pre and post-operation were compared respectively. Results Seven patients appeared the upper extremity abduction and lift limitations. Seven patients were followed up for 8-16 months. Six patients had muscle strength improved completely and 1 patient improved to fourth grade. The mean rate of JOA improvement was 65%. Patients who received less than 2 levels decompression had 1.5%（1/67） of upper extremity functions limitations, while patients who received more than 3 levels decompression had 12%（6/50）. Nine points system of C4-5 disc degeneration in the 7 patients with upper function limitation was 2.1±0.37, while the patients without up-per function limitations was 2.6±1.4. The variation of intervertebral height in C4-5 in the 7 patients with upper function limitation was 2.1±0.66 mm,while the patients without upper function limitation was 2.2±1.1 mm. The rate of C3-5 high signals area in MRI with upper function limitation was 57.1%, while patients who were without upper function limitation was 1.8%. Conclusion The rate of the upper extremity abduction and lift limitation after anterior cervical decompression and fusion is low, which has a good prognosis after active treatment. The patients who had function limitations combined with sensory defect may not ha

关 键 词：颈椎 脊神经 麻痹 脊柱融合术 

分 类 号：R687.3[医药卫生—骨科学]