颈椎后路单开门椎管扩大成形术后并发C5神经根麻痹的危险因素分析  

Risk factors for C5 nerve root palsy after unilateral open door laminoplasty

作　　者：李涛 LI Tao(Department of Spinal Surgery,Central Hospitalof Xuchang,Xuchang,Henan 461000,China)

机构地区：[1]许昌市中心医院脊柱脊髓外科

出　　处：《颈腰痛杂志》2019年第6期736-739,共4页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的探讨颈椎后路单开门椎管扩大成形手术后并发C5神经根麻痹的相关因素,为此类并发症的防治提供参考。方法纳入自2011年2月-2017年2月行颈后路单开门椎管扩大成形术的237例多节段脊髓型颈椎病患者作为观察对象。将术后出现C5神经根麻痹与否,作为自变量;并将性别、年龄、病程,有无发育性椎管狭窄、椎间孔狭窄、后纵韧带骨化、脊髓内缺血信号,术后开门角度、脊髓后移距离、颈椎曲度指数等相关指标作为因变量。对上述10项因变量进行单因素分析;而后,进一步将所有变量代入Logistic回归模型进行处理。结果237例CSM患者手术后,29例并发C5神经根麻痹,发生率为12.24%。单因素分析显示,椎间孔狭窄、后纵韧带骨化、术后开门角度和脊髓后移距离、颈椎曲度指数等5项因素有统计学意义(P<0.05);多因素Logistic回归分析显示,术后开门角度、脊髓后移距离、颈椎曲度指数均为术后并发C5神经根麻痹的独立影响因素之一。结论脊髓后移距离增加、术后开门角度增大和颈椎曲度指数增加,均是颈椎后路单开门椎管扩大成形术后并发C5神经根麻痹的独立危险因素。Objective To explore the related factors of C5 nerve root paralysis after the open door laminoplasty for the cervical spine,so as to provide a reference for the prevention and treatment of such complications.Methods From February 2011 to February 2017,237 patients with multilevel cervical spondylotic myelopathy(CSM)who underwent posterior single-door laminoplasty were included in this study.The occurrence of C5 nerve root paralysis after operation was regarded as independent variable,and the related indicators such as gender,age,course of disease,developmental spinal stenosis,foramen stenosis,ossification of posterior longitudinal ligament,ischemic signal of spinal cord,opening angle,distance of spinal cord retroversion,cervical curvature index were taken as dependent variable.The above 10 dependent variables were analyzed by single factor analysis,and then all variables were further processed by logistic regression model.Results Of 237 CSM patients,29 cases had C5 nerve root paralysis,the incidence rate was 12.24%.Univariate analysis showed that there were significant differences in five factors(P<0.05),including intervertebral foramen stenosis,ossification of posterior longitudinal ligament,open angle and distance of spinal cord retraction,cervical curvature index.Multivariate logistic regression analysis showed that open angle,distance of spinal cord retraction and cervical curvature index were all independent risk factors of C5 nerve root palsy after operation.Conclusion Increased posterior displacement of spinal cord,increased opening angle and cervical curvature index are independent risk factors for C5 nerve root palsy after posterior cervical single-door laminoplasty.

关 键 词：后路单开门椎管扩大成形术 C5神经根麻痹 颈椎曲度 发育性椎管狭窄 脊髓漂移 

分 类 号：R619[医药卫生—外科学]