颈椎术后C_(5)麻痹病因分析及临床干预  

Cause analysis and clinical intervention of C_(5) palsy after cervical surgery

作　　者：徐晨霈 周铭杰 陈楚翔 王洪立 蒋苏[1,2,3,4,5,6] XU Chenpei;ZHOU Mingjie;CHEN Chuxiang;WANG Hongli;JIANG Su(Department of Hand Surgery,Huashan Hospital,Fudan University,Shanghai,200040,P.R.China;National Health Commission Key Laboratory of Hand Reconstruction,Shanghai,200032,P.R.China;Shanghai Key Laboratory of Peripheral Nerve and Microsurgery,Shanghai,200032,P.R.China;National Clinical Research Center for Aging and Medicine,Huashan Hospital,Fudan University,Shanghai,200040,P.R.China;Institute of Hand Surgery,Shanghai,People’s Republic of China,Shanghai,200040,P.R.China;Institute of Hand Surgery,Fudan University,Shanghai,200040,P.R.China;Department of Orthopedics,Huashan Hospital,Fudan University,Shanghai,200040,P.R.China;Spinal Surgery Center,Fudan University,Shanghai,200040,P.R.China)

机构地区：[1]复旦大学附属华山医院手外科,上海200040 [2]国家卫生健康委员会手功能重建重点实验室,上海200032 [3]上海市周围神经显微外科重点实验室,上海200032 [4]复旦大学附属华山医院国家老年疾病临床医学研究中心,上海200040 [5]上海市手外科研究所,上海200040 [6]复旦大学手外科研究所,上海200040 [7]复旦大学附属华山医院骨科,上海200040 [8]复旦大学脊柱外科中心,上海200040

出　　处：《中国修复重建外科杂志》2024年第5期608-612,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家自然科学基金资助项目(82072545);上海市科学技术委员会科技创新计划项目(22S31902100);科技创新2030-重大项目(2022ZD0208605、2022ZD0208600);上海市临床重点专科项目(shslczdzk05601);上海市周围神经与显微外科重点实验室项目(20DZ2270200)。

摘　　要：目的综述颈椎术后C_(5)麻痹(C_(5) palsy,C5P)研究进展,为临床治疗C_(5)P患者提供参考。方法广泛查阅国内外颈椎术后C_(5)P相关文献,系统性阐述C_(5)P发病机制、危险因素、临床表现及诊断、预防、治疗措施新进展。结果C_(5)P为颈椎术后出现的C_(5)神经支配区肌肉无力,表现为肩外展、屈肘受限,发生率>5%,可能由节段性脊髓损伤或神经根机械损伤导致。对于存在危险因素患者,术中仔细操作及采取预防性措施可减少术后C_(5)P的发生。大部分患者经药物治疗、物理治疗等保守治疗后功能可恢复,6个月以上无明显好转者可予以手术干预,可选用椎间孔减压、神经移位等手术方案。结论有关C_(5)P发病机制及预防措施等已取得一定研究进展,但对于干预时机和手术方式仍需进一步研究。Objective To review the research progress of C_(5) palsy(C5P)after cervical surgery,providing new clinical intervention ideas for the C_(5)P patients.Methods The relevant literature domestically and abroad was extensively consulted and the latest developments in the incidence,risk factors,manifestations and diagnosis,prevention,and intervention measures of C_(5)P were systematically expounded.Results C_(5)P is characterized by weakness in the C_(5) nerve innervation area after cervical decompression surgery,manifested as limited shoulder abduction and elbow flexion,with an incidence rate more than 5%,often caused by segmental spinal cord injury or mechanical injury to the nerve roots.For patients with risk factors,careful operation and preventive measures can reduce the incidence of C_(5)P.Most of the patients can recover with conservative treatment such as drug therapy and physical therapy,while those without significant improvement after 6 months of treatment may require surgical intervention such as foraminal decompression and nerve displacement.Conclusion Currently,there has been some advancement in the etiology and intervention of C5P.Nevertheless,further research is imperative to assess the timing of intervention and surgical protocol.

关 键 词：C_(5)麻痹 神经根损伤 颈椎手术 并发症 

分 类 号：R687.3[医药卫生—骨科学]