颈椎后纵韧带骨化症后路手术并发C_5神经根麻痹的临床观察  

Clinical observation on C_5 palsy after posterior approach surgery for ossification of posterior longitudinal ligament

作　　者：罗益滨[1] 王新伟[1] 陈德玉[1] LUO Yi-bin;WANG Xin-wei;CHEN De-yu(Department of Orthopedics,Shanghai Changzheng Hospital,Shanghai 200003,China)

机构地区：[1]上海长征医院骨科,上海200003

出　　处：《中国骨与关节损伤杂志》2018年第9期905-908,共4页Chinese Journal of Bone and Joint Injury

基　　金：国家自然科学基金(81472128)

摘　　要：目的探讨颈椎后路单开门椎管扩大成形术与颈椎后路椎板切除减压椎弓根钉内固定术治疗颈椎后纵韧带骨化症并发C_5神经根麻痹的影响因素,并总结预防和治疗经验。方法回顾性分析自2011-06—2014-06诊治的83例颈椎后纵韧带骨化症,43例行颈后路单开门椎管扩大微型钛板成形术(A组),40例行颈后路椎板切除减压椎弓根钉内固定术(B组)。比较2组术前及末次随访时JOA评分,以及C_5神经根麻痹发生率。结果术后1~3 d内共出现8例(9.6%)C_5神经根麻痹,其中A组出现2例(4.7%),B组出现6例(15.0%);A组术后C_5神经根麻痹发生率低于B组,差异有统计学意义(P <0.05)。8例C_5神经根麻痹患者采用甘露醇脱水及地塞米松治疗,进行积极功能锻炼,症状得到缓解;2例遗留肩部疼痛及关节活动受限,在全身麻醉下行肩关节松解术。2组末次随访时JOA评分较术前明显提高,差异有统计学意义(P <0.05)。结论颈椎后路单开门椎管扩大成形术和椎板切除减压椎弓根钉内固定术治疗颈椎后纵韧带骨化症均能获得有效的神经功能恢复,但颈椎后路椎板切除减压椎弓根钉内固定术后并发C_5神经根麻痹的概率更高,因此需在围手术期进行合理预防和治疗以降低术后C_5神经根麻痹的发生率及其严重程度。Objective To investigate the factors affecting C5 palsy in the treatment of ossification of posterior longitudinal ligament with single-door laminoplasty or laminectomy with pedicle screw internal fixation, and summarize prevention and treatment experience. Methods From June 2011 to June 2014, 83 cases of ossification of posterior longitudinal ligament were analyzed retrospectively. Forty-three cases were treated with single door laminoplasty and mini titanium plate fixation （group A） while 40 cases underwent laminectomy with pedicle screw fixation （group B）. The JOA score and the incidence of C5 palsy were compared between the two groups preoperatively and at last follow-up. Results. C5 palsy occurred in eight cases （9.6%） at 1-3 d after operation, 2 cases （4.7%） in group A and 6 cases （15%） in group B. The incidence of C5 palsy in group A was lower than that in group B, and the difference was statistically significant （P 〈0.05）. Eight cases of C5 palsy were treated with mannitol and dexamethasone and active functional exercise. All the symptoms were relieved, 2 cases had shoulder pain and limited joint activity, and the shoulder joint relax was performed under general anesthesia. The JOA scores of the 2 groups at the last follow-up were significantly higher than those before operation, and the difference was statistically significant （P 〈 0.05）. Conclusion Both of the two methods for the treatment of the ossification of posterior longitudinal ligament can achieve effective nerve function recovery. The probability of C5 palsy complicated by laminectomy with pedicle screw fixation is higher. Therefore, it is necessary to prevent and treat the incidence of Cs palsy and its severity during the perioperative period.

关 键 词：颈椎后纵韧带骨化症 颈后路单开门椎管扩大成形术 颈后路椎板切除减压椎弓根钉内固定术 C5神经根麻痹 

分 类 号：R681.5[医药卫生—骨科学]