颈椎后路椎管扩大成形术后C5神经根麻痹相关因素分析  

Factors related to C5 nerve root palsy after open-door cervical expansive laminoplasty

作　　者：窦永峰[1] 孙兆忠[1] 耿晓鹏[1] 房清敏[1] 孙宁[1] 朱锴[1] DOU Yong-feng;SUN Zhao-zhong;GENG Xiao-peng;FANG Qing-min;SUN Ning;ZHU Kai(Department of Orthopaedics,The Affiliated Hospital,Binzhou Medical University,Binzhou256603 ,China)

机构地区：[1]山东滨州医学院附属医院骨科

出　　处：《中国矫形外科杂志》2019年第19期1739-1743,共5页Orthopedic Journal of China

基　　金：山东省高等学校科技计划项目(编号：J14LL51)

摘　　要：[目的]分析颈椎后路单开门椎管扩大成形术术后C5神经根麻痹发生的相关因素,探讨术后C5神经根麻痹的病因及发病机制。[方法]回顾性分析2008年1月~2014年1月本院骨科收治行颈椎后路单开门椎管扩大成形术并有完整随访资料的脊髓型颈椎病患者153例,平均年龄(58.87±6.85)岁,男性98例,女性55例。观察术后是否发生C5神经根麻痹,分析术前肌电图改变、颈椎曲度与C5神经根麻痹发生的相关性。[结果]153例患者中12例发生C5神经根麻痹,占7.84%。麻痹组与非麻痹组的患者在年龄、性别构成方面差异无统计学意义(P>0.05),麻痹组术前肌电图异常发生率显著高于非麻痹组(P<0.05),麻痹组术前颈椎曲度显著大于非麻痹组(P<0.05),麻痹组术后颈椎曲度大于非麻痹组,但差异无统计学意义(P>0.05)。多元逻辑回归分析表明:术前肌电图异常、术前颈椎曲度过大,均为术后C5神经根麻痹发生的独立危险因素。至末次随访时,麻痹组JOA评分平均改善率为(50.18±14.53)%,而非麻痹组为(61.94±16.76)%,两组间差异有统计学意义(P<0.05)。[结论]术前肌电图异常,术前颈椎曲度较大,是术后发生C5神经根神经根麻痹的危险因素;C5神经根麻痹对术后疗效有一定影响。[Objective] To analyze the factors related to C5 nerve root palsy after open-door cervical expansive laminoplasty for cervical myelopathy, and investigate the clinical features and possible pathogenesis of postoperative C5 nerve root palsy.[Methods] From January 2008 to January 2014, a total of 153 patients, including 98 males and 55 females aged (58.87±6.85) years on anaverage, underwent open-door cervical expansive laminoplasty for multilevel cervical spondylotic myelopathy in our institution. Whether or not postoperative C5 palsy happened and its correlation to preoperative change of electromyography (EMG), the pre- and post-operative cervical curvatures were analyzed.[Results] Of the 153 patients, 12 patients suffered from postoperative C5 palsy, accounted for 7.84%. There were no significant differences in age and genders between the palsy group and non-palsy group (P>0.05). However, the palsy group had significantly higher ratio of abnormal EMG preoperatively, significantly greater preoperative cervical curvature than the non-palsy group (P<0.05). Although the palsy group also had greater postoperative cervical curvature than the non-palsy group, it was proved of no statistical significance (P>0.05). As results of multiple logistical regression analysis, the preoperative abnormalities of EMG and greater preoperative cervical curvature were the independent risk factors for postoperative C5 palsy. In addition, the improved rate of JOA score at the latest follow up proved of (50.18±14.53)% in the palsy group, while (61.94±16.76)% in the non-palsy group, which was statistically significant (P< 0.05).[Conclusion] The preoperative abnormal EMG and greater cervical curvature are the risk factors for C5 palsy, which impacts the clinical outcomes of open-door cervical expansive laminoplasty for multiple cervical myelopathy.

关 键 词：颈椎后路椎管扩大成形术 C5神经根麻痹 肌电图 颈椎曲度 JOA改善率 

分 类 号：R687[医药卫生—骨科学]