有限椎板切除联合神经根管减压预防C_5神经根麻痹的效果  

Effect of Limited Laminectomy Combined with Foraminal Stenosis Decompression on Preventing C_5 Palsy

作　　者：刘炳智[1] 田金辉 李志远 李晓东[1] 苗洁[1] 刘法敬[1] LIU Bing-zhi;TIAN Jin-hui;LI Zhi-yuan;LI Xiao-dong;MIAO Jie;LIU Fa-jin(The Fifth Department of Orthopedics,Handan Central Hospital,Handan,Hebei 056001,China)

机构地区：[1]邯郸市中心医院骨5科,河北邯郸市056001

出　　处：《中国康复理论与实践》2018年第4期447-452,共6页Chinese Journal of Rehabilitation Theory and Practice

基　　金：河北省医学科学研究重点课题(No.20150452)~~

摘　　要：目的观察颈后路有限椎板切除联合神经根管减压术在降低C_5神经根麻痹及其促进神经功能改善的作用。方法回顾性分析2014年3月至2016年5月69例在本院接受手术治疗的多节段脊髓型颈椎病患者,其中,38例采用有限椎板切除、神经根管减压内固定术治疗(A组),31例采用常规椎板切除内固定术治疗(B组)。术后观察患者神经功能恢复、颈椎曲度指数变化及C_5神经根麻痹发生情况。结果所有手术均顺利完成。A组患者椎板切除宽度(16.8±2.1)mm,显著小于B组(21.7±2.5)mm(t=8.849,P<0.001)。两组在手术时间、术中出血量上比较无显著性差异(t<0.439,P>0.05)。术后两组日本骨科协会(JOA)评分持续性升高(F>42.996,P<0.05),不同时间点组间比较无显著性差异(t<1.021,P>0.05);颈椎曲度指数较术前有改善,且维持至末次随访(F>86.379,P<0.05),不同时间点组间比较无显著性差异(t<0.943,P>0.05)。A组术后C5水平脊髓漂移距离(2.5±0.5)mm,显著小于B组(3.6±0.7)mm(t=7.602,P<0.001)。两组神经功能改善率无显著性差异(t=0.724,P=0.471)。A组C5神经根麻痹发生率5.2%(2/38),低于B组22.5%(7/31)(χ~2=4.514,P=0.034)。结论颈椎有限椎板切除联合神经根管减压术可解除脊髓压迫并限制脊髓过度向后漂移,促进神经功能恢复的同时降低C_5神经根麻痹的发生。Objective To observe the effect of limited laminectomy combined with foraminal stenosis decompression on preventing C5 nerve root palsy and improving neurological function.Methods From March,2014 to May,2016,69 patients with multi-segment cervical spondylotic myelopathy underwent surgical treatment in our hospital were included.Thirty-eight patients(group A)were treated with limited laminectomy combined with foraminal stenosis decompression and internal fixation,and 31 patients(group B)underwent routine laminectomy and internal fixation.The postoperative neurological recovery rate,cervical curvature index(CCI)and C5 palsy rate were recorded and analyzed.Results No spinal cord and nerve injury occurred during the operation.The width of laminectomy was(16.8±2.1)mm in group A,and was significantly less than(21.7±2.5)mm in group B(t=8.849,P<0.001).There was no significant difference in operation time and intraoperative blood loss between two groups(t<0.439,P>0.05).The Japanese Orthopaedic Association(JOA)score increased continuously after surgery in both groups(F>42.996,P<0.05),and no significant difference was found between them at each time point(t<1.021,P>0.05).The cervical curva-ture index improved after surgery(F>86.379,P<0.05),and no significant difference was found between them at each time point(t<0.943,P>0.05).The spinal cord drift distance was(3.6±0.7)mm in group A,and ws significantly shorter than(2.5±0.5)mm in group B(t=7.602,P<0.001).There was no significantly difference in the neurological recovery rate between two groups(t=0.724,P=0.471).The C5 palsy rate was lower in group A(5.2%,2/38)than in group B(22.5%,7/31)(χ2=4.514,P=0.034).Conclusion Limited laminectomy combined with foraminal stenosis decompression could relieve the spinal cord compression and restrict the excessive back drift,promote the neurological function recovery and reduce the incidence of C5 palsy.

关 键 词：脊髓型颈椎病 有限椎板切除 神经根管减压 C5神经根麻痹 

分 类 号：R681.5[医药卫生—骨科学]