颈椎前路减压融合术后颈5神经根麻痹的相关危险因素分析  

Analysis of related risk factors of C5 nerve root palsy after anterior cervical decompression and fusion

作　　者：张杨[1] 谭洪宇[1] 宋瑞鹏[1] 王利民[1] Zhang Yang;Tan Hongyu;Song Ruipeng;Wang Limin(Department of Orthopaedics,First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院骨科,450052

出　　处：《中华实验外科杂志》2022年第10期2008-2011,共4页Chinese Journal of Experimental Surgery

摘　　要：目的分析颈椎前路减压融合术后颈5神经根麻痹的危险因素,探讨相应的预防和治疗措施。方法收集2016年1月至2020年12月因颈椎病于本院行颈椎前路减压融合术的患者共168例(均包含颈4/5节段),其中10例(6%)术后出现颈5神经根麻痹,作为麻痹组,其余作为正常组。统计两组患者术前一般资料、术后临床和影像学指标。两组间比较采用两独立样本t检验和χ^(2)检验。结果麻痹组术前颈椎曲率指数(CCI)与正常组比较差异无统计学意义[(8.60±3.10)%比(10.12±2.61)%,t=1.766,P>0.05];麻痹组术后CCI高于正常组[(14.11±2.15)%比(12.73±1.76)%,t=2.360,P<0.05];麻痹组CCI变化值高于正常组[(6.29±1.55)%比(3.16±1.67)%,t=5.774,P<0.05];麻痹组C4/5水平脊髓旋转角度(SRA)高于正常组[(5.59±1.81)°比(2.12±0.87)°,t=11.258,P<0.05];麻痹组减压节段高于正常组[(2.60±0.52)个比(1.89±0.68)个,t=3.271,P<0.05];麻痹组C4/5节段椎间孔前后径小于正常组[(2.21±0.71)mm比(3.33±0.99)mm,t=3.549,P<0.05];麻痹组C4/5节段突出钙化比率高于正常组[5/10比30/158,χ^(2)=3.765,P<0.05];麻痹组C3~5脊髓内高信号(HIZ)发生率高于正常组[4/10比12/158,χ^(2)=3.765,P<0.05];麻痹组日本骨科协会评分(JOA)术前、术后12月与正常组比较差异无统计学意义[(7.60±2.22)分比(8.12±1.55)分,t=0.999,P>0.05,术后12月(15.60±0.70)分比(16.01±0.71)分,t=1.758,P>0.05];麻痹组术后2周JOA评分低于正常组[(12.10±0.99)分比(15.12±0.89)分,t=10.340,P<0.05];麻痹组颈椎功能障碍指数(NDI)术前、术后12月与正常组比较差异无统计学意义[术前(24.61±3.16)%比(25.99±2.31)%,t=1.790,P>0.05;术后12月(4.80±0.92)%比(4.35±0.87)%,t=1.558,P>0.05];麻痹组术后2周NDI指数高于正常组[(15.67±1.23)%比(8.23±0.97)%,t=29.256,P<0.05]。结论颈椎曲度矫正过多、C4/5椎间孔狭窄、C4/5突出钙化、C3~5脊髓内HIZ、C4/5水平脊髓旋转,减压节段过长都是ADF术后出现C5P的危险因素,对C5P麻痹�Objective To analyze the risk factors of cervical 5 nevve root plasy after anterior cervical decompression and fusion,to explore the prevention and cure of C5 palsy.Methods The subjects were 168 patients with cervical myelopathy who underwent anterior cervical decompression and fusion including C4/5 disk at our hospital from 2016.01 to 2020.12.10 of these patients(6.0%)had C5 palsy postoperative as C5P group,the others as normal group.Clinical features and imaging findings were compared in patients with and without C5 palsy.Two independent samples t-test andχ^(2) inspection were used for comparison between the two groups.Results The preoperative cervical curvature index(CCI)in the paralysis group was not statistically significant compared with the normal group[(8.60±3.10)%vs.(10.12±2.61)%,t=1.766,P>0.05];the postoperative CCI in the paralysis group was higher than that in the normal group[(14.11±2.15)%vs.(12.73±1.76)%,t=2.360,P<0.05];the value of CCI change was higher in the paralyzed group than in the normal group[(6.29±1.55)%vs.(3.16±1.67)%,t=5.774,P<0.05];the spinal cord rotation angle(SRA)at C4/5 level was higher in the paralysis group than in the normal group[(5.59±1.81)°vs.(2.12±0.87)°,t=11.258,P<0.05];the decompressed segments were higher in the paralysis group than in the normal group[(2.60±0.52)segments vs.(1.89±0.68)segments,t=3.271,P<0.05];the anterior-posterior diameter of C4/5 segments in the palsy group was smaller than that in the normal group[(2.21±0.71)mm vs.(3.33±0.99)mm,t=3.549,P<0.05];the rate of prominent calcification in C4/5 segments was higher in the paralyzed group than in the normal group[5/10 vs.30/158,χ^(2)=3.765,P<0.05];the incidence of high intensity zone(HIZ)in C3-5 spinal cord was higher in the paralyzed group than in the normal group[4/10 vs.12/158,χ^(2)=3.765,P<0.05];there was no statistically significant difference in the Japanese orthopaedic association(JOA)score in the paralysis group preoperative and 12 months after surgery compared with the normal group[preo

关 键 词：颈椎前路减压融合术 颈5神经根麻痹 颈椎病 危险因素 

分 类 号：R687.3[医药卫生—骨科学]