不同术式治疗对颈椎管狭窄症患者神经功能和C5神经麻痹发生率影响的比较临床研究  

Influence of different surgical treatment to neurological function and the incidence rate of C_5 nerve palsy in patients with cervical spinal stenosis

作　　者：陈善堂 

机构地区：[1]海南三亚市人民医院骨科,海南三亚572000

出　　处：《颈腰痛杂志》2018年第1期44-47,共4页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的比较经单开门椎管扩大成形术与后路椎板减压侧块内固定术对颈椎管狭窄症(CCS)患者神经功能恢复情况和C5神经麻痹(C5P)发生率。方法选取我院2013-06-2015-01收治的颈椎管狭窄症患者84例,采用随机数字法将其分为对照组和观察组,每组各42例,对照组患者采用后路椎板减压侧块内固定术治疗,观察组患者采用单开门椎管扩大成形术进行治疗,术后随访比较两组患者术前和术后不同时期JOA评分,比较两组患者的C5P发生率,同时比较两组患者术前和术后颈椎前凸角度(Cobb角)和颈椎曲度指数(CCI)差异。结果观察组和对照组术后2个月、4个月、8个月及1年的JOA评分均明显高于手术前(P<0.01),观察组患者术后C5P发生率为4.76%,对照组患者术后C5P发生率为16.66%,观察组明显低于对照组(χ~2=5.83,P=0.01),重度C5P的康复时间明显高于轻度C5P(P<0.01),两组患者术后Cobb角和CCI均低于手术前,但无统计学差异(P>0.05),两组患者组间比较差异无统计学意义(P>0.05)。结论采用单开门椎管扩大成形术与后路椎板减压侧块内固定术均能够有效改善患者的神经功能及Cobb角和CCI,具有较好的临床疗效,但单开门椎管扩大成形术治疗的患者术后发生C5P发生率更低,同时发现椎间孔狭窄和脊髓漂移程度与C5P发生存在密切联系。Objective To compare the effects of single door laminoplasty and laminectomy and posterior lateral mass fixation on neurological recovery and C5 nerve palsy（C5P） incidence in cervical spinal stenosis（CCS） patients. Methods 84 cases of cervical stenosis were selected in our hospital from June 2013 to January 2015. All patients were divided into control group and observation group by using random numbers method,42 cases in each group. The control group was treated with posterior laminectomy lateral mass fixation treatment, the observation group was treated with open-door laminoplasty. Before and after surgery, JOA scores at different time were compared. The C5P incidence rate, cervical lordosis（Cobb angle） and cervical curvature index（CCI） were compared in the two groups before and after surgery.Results After 2 months, 4 months, 8 months and 1 year of surgery, JOA scores of observation group and the control group were significantly higher than before surgery（P〈0.01）. The incidence rate of C5P in the observation group was 4.76%, which was significantly lower than 16.66% in the control group（X^2=5.83,P=0.01）. The recovery time of severe C5P was significantly longer than mild C5P（P〈0.01）. After surgery,the Cobb angle and CCI of two groups were lower than before surgery, but had no significant difference（P〈0.05）, the difference was not statistically significant between the two groups（P〈0.05）. Conclusion A single door laminoplasty with the lamina posterior lateral mass fixation decompression are able to effectively improve the patients＇ neurological function, Cobb angle and CCI, with better clinical efficacy,but the single door canal postoperative expand angioplasty has lower incidence rate of C5P, also found that intervertebral foramen stenosis and the degree of spinal cord drift closely linked with C5P occurrence.

关 键 词：单开门椎管扩大成形术 后路椎板减压侧块内固定术 颈椎管狭窄症 神经功能 C5P发生率 

分 类 号：R687.3[医药卫生—骨科学] R681.55[医药卫生—外科学]