颈前路减压融合术后颈椎曲度改变对C_5神经根麻痹的影响  

Effect of cervical curvature change on C_5 nerve root palsy after anterior cervical decompression and fusion

作　　者：段钢[1] 贾星海[1] 冉波[2] 陈宏亮[2] 朱自强[1] 闫长明[1] 李高玉 刘刚[1] 王斌[1] 

机构地区：[1]徐州医学院第二附属医院骨科 [2]徐州医学院附属医院骨科,徐州221000

出　　处：《中国矫形外科杂志》2015年第13期1169-1172,共4页Orthopedic Journal of China

摘　　要：[目的]探讨不同节段颈前路减压融合术后颈椎曲度改变对C5神经根麻痹的影响。[方法]回顾性分析2009年3月～2013年8月,本治疗组行颈椎前路减压植骨融合术治疗颈椎病及颈椎后纵韧带骨化症病例共78例的临床资料,按照手术减压节段分组,A组：减压1～2节段患者;B组：减压3～4节段患者,采用颈脊髓病功能评估（japanese orthopedic association,JOA）评价两组患者的临床疗效,测量两组患者术前、术后颈椎曲度指数（cervical curvature index,CCI）及颈椎前凸角度（Cobb角）,并行统计学分析。[结果]A组发生C5神经根麻痹1例,B组发生C5神经根麻痹6例,两组间差异有统计学意义（P〈0.05）。同时B组手术后的CCI改变率大于A组,且B组术后颈椎前凸角度和CCI均较术前增大,差异有统计学意义（P〈0.05）。B组手术前后的JOA评分与A组比较差异无统计学意义（P〉0.05）。[结论]多节段减压融合使椎间隙撑开增加致术后颈椎曲度明显改变是发生C5神经根损伤的可能因素。[Objective] To investigate the effect of cervical curvature change on C5 nerve root palsy after anterior cervical decompression and fusion. [Methods] We retrospectively analyzed cases from our hospital that were documented between March 2009 and August 2013. The clinical data of 78 cases were analyzed. Group A consisted of 40 patients who underwent 1-or 2- segment decompression. Group B consisted of 48 patients who underwent 3- or 4- segment decompression. We used the Japanese Orthopedic Association（ JOA） scoring system to evaluate the clinical efficacy of the 2 groups,and measured the preoperative and postoperative cervical curvature indexes（ CCI） and cervical lordosis angle（ Cobb angle）,and performed statistical analysis. [Results] C5 nerve root palsy occurred in 1 patient in group A and 6 patients in group B,showing a statistically significant difference（ P 0. 05）. The postoperative CCI change rate was greater in group B than in group A. The postoperative cervical Cobb angle and CCI increased in group B,which statistically significantly differed from those in group A（ P 0. 05）.The JOA scores before and after operation in group B did not statistically significantly differ from those in group A（ P 0. 05）.[Conclusion] Multiple segmental decompression and fusion increases the intervertebral disc gap,and postoperative cervical curvature change is a possible factor of C5 nerve root injury.

关 键 词：颈前路 颈椎曲度 C5神经根麻痹 

分 类 号：R687.3[医药卫生—骨科学]