颈前路减压术中影响肌肉萎缩型颈椎病预后的相关因素分析  

Analysis of predictive factors relating to prognosis of anterior decompressive surgery for proximal-type cervical spondylotic amyotrophy

作　　者：王飞[1] 胡成栋[1] 霍喜卫[1] 陈怀志[1] 李东风[1] 刘法敬[1] 

机构地区：[1]河北省邯郸市中心医院,河北邯郸056001

出　　处：《现代中西医结合杂志》2014年第31期3438-3440,共3页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：河北省科技计划项目(12277750)

摘　　要：目的探讨颈前路减压术中影响上肢近端肌肉萎缩型颈椎病(CSA)预后的相关因素。方法 40例CSA行颈前路减压术治疗患者根据磁共振成像(MRI)分为神经根受压组6例和脊髓受压组34例。以肌力试验来评价术后效果,从年龄、病程、术前肌力、受累节段、有无脊髓信号改变等临床及影像学指标中分析影响预后的因素。结果治疗后,共有29例(73%)患者的肌力得到改善。其中神经根受压组患者肌力均得到改善,而脊髓受压组患者仅有23例(68%)获得改善。脊髓受压组中,肌力无改善患者的病程明显比肌力有改善者的病程长(P<0.01),而其他因素2组比较差异无统计学意义。结论颈前路减压术是治疗CSA的有效手段。在MRI上显示为神经根受压的患者术后肌力恢复好,而表现为脊髓受压及病程长的患者多预后不良。Objective It is to elucidate the prognosis of proximal-type cervical spondylotic amyotrophy（ CSA） after anterior decompressive surgery by evaluation of clinical factors and imaging findings. Methods 40 patients with proximal-type CSA were treated with anterior decompressive surgery. The patients were divided into 2 groups according to MRI： nerve root compression（ NRC） group with 6 cases and spinal cord compression（ SCC） group with 34 cases. Manual muscle testing（ MMT）was used to evaluate surgical outcomes. The clinical factors and imaging findings,including age,duration of disease,preoperative MMT,number of affected intervertebral levels,signal intensity change on MRI,were collected to analyze predictive factors. Results After surgical treatment,the muscle strength was improved in 29 patients（ 73%）,in which all patients（ 100%） with NRC had improvement,while only23 patients（ 68%） with SCC improved. In the patients with SCC,there was significant difference in mean duration of disease between patients who had improvement and those who had not（ P〈0.01）.For other factors,there was no significant difference in the patients between the two groups. Conclusion Anterior surgery is effective in the treatment of proximal-type CSA. NRC on MRI may indicate good surgical outcome. In patients with SCC,a long duration of disease is a risk factor for poor prognosis.

关 键 词：肌萎缩型颈椎病 前路手术 预后因素 磁共振 

分 类 号：R681.55[医药卫生—骨科学]