肌萎缩型颈椎病分型、诊断、治疗及预后中的不同问题  

Cervical spondylotic amyotrophy:problems about classification,diagnosis,treatment,and prognosis

作　　者：吕帅尧 关海山[1] 郝晨 丁壮志 Lü Shuaiyao;Guan Haishan;Hao Chen;Ding Zhuangzhi(Department of Orthopedics,Second Hospital of Shanxi Medical University,Taiyuan 030001,Shanxi Province,China)

机构地区：[1]山西医科大学第二医院骨科,山西省太原市030001

出　　处：《中国组织工程研究》2022年第11期1788-1792,共5页Chinese Journal of Tissue Engineering Research

摘　　要：背景:肌萎缩型颈椎病治疗方法仍有争议。对于肌萎缩型颈椎病患者,保守治疗一般可以稳定或者改善症状,但无法治愈。进展性或严重的神经功能恶化的肌萎缩型颈椎病推荐手术治疗,但多数临床医师根据自己的临床经验选择手术方式,尚未达成统一的标准或行业共识。不同分型的肌萎缩型颈椎病预后显著不同,可能影响手术方案选的选择。目的:通过对肌萎缩型颈椎病相关研究进行综述,总结并分析疾病发病机制、临床表现、分型、诊断、治疗和预后情况,以期为此病的临床治疗和手术方案选择提供参考。方法:通过计算机检索1952-2020年发表在PubMed、EMbase、Web of Science、中国知网和万方数据库的肌萎缩型颈椎病相关研究文章,选择符合纳入标准的44篇文献进行综述。结果与结论:(1)肌萎缩型颈椎病的临床表现以上肢运动无力伴有明显的肌肉萎缩,而下肢没有明显的感觉障碍或痉挛性麻痹为特征,具有不对称性、节段性等特点;(2)临床多采用依据肌肉萎缩位置的不同进行分型,分为近端型、远端型和混合型,该疾病需与运动神经元病、肌肉营养不良疾病相鉴别,避免误诊和误治;(3)目前关于肌萎缩型颈椎病的发病机制尚不清楚,有腹侧神经根和脊髓前角细胞损伤两种观点,后者得到大部分学者认可;(4)肌萎缩型颈椎病的诊断主要依据临床症状、影像学检查及神经电生理检查,鉴别诊断上主要需排除运动神经元病等;(5)肌萎缩型颈椎病的治疗以手术为主,颈椎前路前路手术是治疗首选,而对于多节段颈椎后纵韧带骨化、前路不可能减压或者减压风险太大的患者需选择后路手术;(6)不同类型肌萎缩型颈椎病患者术后取得的预后效果有一定差异,其中近端型较远端型预后效果更佳,混合型预后最差,颈椎前路较后路手术效果佳。BACKGROUND:Treatments for cervical spondylotic amyotrophy are still controversial.For cervical spondylotic amyotrophy patients,conservative treatment can generally stabilize or improve symptoms,but there is no cure.Surgical treatment is recommended for cervical spondylotic amyotrophy with progressive or severe neurological deterioration;however,most clinicians choose surgical methods based on their own clinical experience,and there is no unified standard or industry consensus.The prognosis of different types of cervical spondylotic amyotrophy is significantly different,which may influence the selection of surgical options.OBJECTIVE:To summarize and analyze the pathogenesis,diagnosis,clinical manifestations,types,treatments,and prognosis of cervical spondylotic amyotrophy by reviewing the related researches of cervical spondylotic amyotrophy,in order to provide reference for the selection of clinical treatment and surgical options.METHODS:Articles related to cervical spondylotic amyotrophy published from 1952 to 2020 were retrieved by computer in PubMed,EMbase,Web of Science,CNKI,and WanFang databases.Finally 44 articles that met the inclusion criteria were selected.RESULTS AND CONCLUSION:The clinical manifestations of cervical spondylotic amyotrophy are asymmetry,segmental and other characteristics of upper limb motor weakness accompanied by obvious muscle atrophy,while the lower limbs are not characterized by obvious sensory disturbance or spastic paralysis.Clinically,according to the position of muscle atrophy,it is classified into proximal type,distal type and mixed type.This disease needs to be distinguished from motor neuron disease and muscular dystrophy to avoid misdiagnosis and erroneous treatment.The pathogenesis of cervical spondylotic amyotrophy is yet unclear.There are two views on ventral nerve root and spinal anterior horn injury.The latter is recognized by most scholars.The diagnosis of cervical spondylotic amyotrophy is mainly based on clinical symptoms,imaging examinations,and neuroelectrophysiol

关 键 词：颈椎病 肌肉萎缩 上肢 神经根 脊髓前角细胞 运动神经元病 机制 预后 

分 类 号：R459.9[医药卫生—治疗学] R319[医药卫生—临床医学]