颈后路单开门椎板成形术后发生C_5神经根麻痹的原因分析  

Outcomes and related factors of C_5 nerve root palsy after cervical posterior single open-door laminoplasty

作　　者：周洋[1] 滕红林[1] 王靖[1] 朱旻宇[1] 李驰[1] 

机构地区：[1]温州医科大学附属第一医院,浙江温州325000

出　　处：《中国骨伤》2016年第11期1011-1015,共5页China Journal of Orthopaedics and Traumatology

摘　　要：目的：分析两种颈后路单开门椎板成形术治疗多节段脊髓型颈椎病术后C5神经根麻痹的发生率和影响因素。方法：对2010年1月至2014年6月因多节段脊髓型颈椎病接受椎管成形术160例患者的临床资料进行回顾性分析,其中80例接受4节段（C3-C6）椎管成形术（A组）,男44例,女36例,平均年龄（68.4±9.2）岁;80例接受3节段（C4-C6）椎管成形术（B组）,男48例,女32例,平均年龄（66.8±8.9）岁。术前及末次随访时分别记录颈痛VAS评分,上肢痛VAS评分,JOA评分,MR最小脊髓直径,颈椎的Cobb角及活动度。术后观察C5神经根麻痹的发生率,及C5神经根麻痹时三角肌肌力,伴随神经症状,恢复时间。结果：所有患者获随访,时间6-15个月,平均（12.4±3.2）个月。手术前后两组患者的颈痛VAS评分、上肢痛VAS评分、JOA评分、MRI最小脊髓直径、颈椎的Cobb角及活动度差异无统计学意义。A组患者中7例（8.75%）发生C5神经根麻痹,其中4例出现上肢放射痛,3例出现上肢感觉减退;在末次随访时2例残留轻微的上肢放射痛及感觉减退。B组患者中5例（7.5%）发生C5神经根麻痹,其中3例出现上肢放射痛,2例出现上肢感觉减退,在末次随访时所有患者上肢放射痛及感觉减退均恢复正常。两组C5神经根麻痹的患者发生率差异无统计学意义。C5神经根麻痹时三角肌肌力、伴随神经症状、恢复时间A组分别为（2.3±1.0）N、30例（37.5%）、（11.4±1.0）周,B组分别为（2.8±0.8）N、23例（28.8%）、（8.2±0.8）周,三角肌肌力下降两组差异无统计学意义,伴随神经症状及恢复时间A组比B组差。结论：两种术式相比,患者术后出现C5神经根麻痹的概率相当,但是C4-C6单开门椎管成形术患者C5神经根麻痹症状较轻,恢复较快。Objective：To analyze the clinical outcomes and related factors of C5 palsy following cervical laminectomy in treating multi segments cervical spondylotic myelopathy. Methods：From January 2010 to June 2014,80 patients with spondylotic myelopathy underwent C3-C6 open door laminoplasty（group A） and 80 patients C4-C6 open door laminoplasty（group B）.The mean age was（68.4±9.2） years（44 males and 36 females） in group A and the mean age was（66.8±8.9） years（48 males and 32 females） in group B. Japanese Orthopaedic Association（JOA） score,Visual Analogue Score,incidence of C5 palsy,time of onset,grade of muscle weakness,other accompanying cervical nerve root palsies,recovery time were used to evaluate clinical effects before operation and at last follow up. Radiographically,changes of Cobb angle of sagittal plane from C2-C7,cervical range of motion,minimal spinal cord diameter on MRI were analyzed before operation and at last follow up. Results：All the patients were followed up from 6 to 15 months with an average of（12.4±3.2） months. No obvious differences were observed between change of VAS of cervical and upper limb,JOA,Cobb angle,cervical range of motion,minimal spinal cord diameter on MRI. C5 nerve root palsy occurred in 7 cases（8.75%） in group A,including 4 cases of upper limb pain,3 cases of upper limb pain,and 2 cases of residual upper limb pain and sensory loss at the last follow-up. C5 nerve root palsy occurred in 5 cases（7.5%） in group B,3 cases of upper limb pain,2 cases of upper limb sensory loss,and all patients recovered normal radiation pain and sensory loss at the last follow up. There was no significant difference in the incidence of C5 nerve root palsy between the two groups. C5 nerve root palsy,deltoid muscle,accompanied by neurological symptoms,recovery time were（2.3±1.0） N,30cases（37.5%）,（11.4±1.0） weeks in group A,（2.8±0.8） N,23 cases（28.8%）,（8.2±0.8） weeks in group B,there was no significant difference on deltoid muscle decre

关 键 词：颈椎 椎板成形术 神经根病 病例对照研究 

分 类 号：R681.55[医药卫生—骨科学]