颈椎后路减压并发C_5神经根麻痹的病因分析
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摘要
目的探讨颈椎后路全板减压术中行C_(4～5)神经根孔扩大减压预防术后C_5神经根麻痹的有效性及其病因分析。方法回顾性分析2011年1月—2015年12月收治的127例行颈后路全板减压侧块内固定术的患者资料,男62例,女65例。其中,A组61例(男28例,女33例)行后路C~(3～7)全椎板减压固定,B组66例(男34例,女32例)后路C_(3～7)减压固定的同时行C_(4～5)双侧椎间孔扩大减压术。回顾性分析2组患者术后C_5神经根麻痹的发生率和脊髓功能改善率差异。结果 2组组内手术前、后JOA评分及颈椎曲度指数(CCI)变化的比较,差异有统计学意义。术后出现C_5神经根麻痹症状A组11例(18.03%),B组3例(4.55%),2组发生率差异有统计学意义(P=0.022)。结论颈椎后路全板减压能有效改善脊髓功能,C_5神经根通道扩大减压能有效预防术后发生C_5神经根麻痹。
Objective To evaluate the effects of C_(4-5) partial foraminotomy on reducing the occurrence of C_5 palsy afterposterior cervical decompression surgery. Methods A total of 127 patients(male 62, female 65) underwent the cervicaldecompression surgery with lateral cervical mass screw insertion between January 2011 and December 2015 wereretrospectively analyzed. In these patients sixty-one cases(Group A) underwent the posterior laminectomy with lateralcervical mass screw insertion, while 66 cases(Group B) received posterior laminectomy with lateral cervical mass screwinsertion, combined with partial C_(4/5) foraminotomy at C_(4-5) level. The clinical data, radiographic parameters and the occurrenceof C_5 palsy were assessed in two groups of patients. Results There was no significant difference in JOA recovery rate andchange of cervical curvature index between preoperation and postoperation in each group(P>0.05). Postoperative C_5 palsyoccurred in 11 cases(18.03%) in group A and 3 cases(4.05%) in group B. The difference in the incidence of C_5 palsy was significant between the two groups(P=0.022). Conclusion The cervical decompression surgery can improve the function ofthe spinal cord effectively. C_(4-5) partial foraminotomy after cervical decompression surgery is effective for preventing C_5 palsy.
Objective To evaluate the effects of C_(4-5) partial foraminotomy on reducing the occurrence of C_5 palsy afterposterior cervical decompression surgery. Methods A total of 127 patients(male 62, female 65) underwent the cervicaldecompression surgery with lateral cervical mass screw insertion between January 2011 and December 2015 wereretrospectively analyzed. In these patients sixty-one cases(Group A) underwent the posterior laminectomy with lateralcervical mass screw insertion, while 66 cases(Group B) received posterior laminectomy with lateral cervical mass screwinsertion, combined with partial C_(4/5) foraminotomy at C_(4-5) level. The clinical data, radiographic parameters and the occurrenceof C_5 palsy were assessed in two groups of patients. Results There was no significant difference in JOA recovery rate andchange of cervical curvature index between preoperation and postoperation in each group(P>0.05). Postoperative C_5 palsyoccurred in 11 cases(18.03%) in group A and 3 cases(4.05%) in group B. The difference in the incidence of C_5 palsy was significant between the two groups(P=0.022). Conclusion The cervical decompression surgery can improve the function ofthe spinal cord effectively. C_(4-5) partial foraminotomy after cervical decompression surgery is effective for preventing C_5 palsy.
引文
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[11]Mitchell R,Klement MD,Lindsay T,et al.C5 palsy after cervicallaminectomy and fusion:does width of laminectomy matter?[J].Spine J,2016,16(4):462-467.doi:10.1016/j.spinee.2015.07.437.
[2]Ishihara A.Roentgenographic studies on the normal pattern of thecervical curvature[J].Nihon Seikeigeka Gakkai Zasshi,1968,42(11):1033-1044.
[3]Meng H,Fang X,Hao D,et al.Incidences of C5 nerve palsy aftermulti-segmental cervical decompression through differentapproaches[J].J South Med Univ,2015,35(3):315-318.
[4]Scoville WB.Cervical spondylosis treated by bilateral facetectomyand laminoplasty[J].J Neurosurg,1961,18(3):423-428.
[5]Stoops WL.Neural complication of cervical spondylosis:theirresponse to lamnoplasty and foraminotomy[J].J Neurosurg,1961,19(7):986-999.
[6]Wu FL,Sun Y,Pan SF,et al.Risk factors associated with upperextremity palsy after expansive open-door laminoplasty for cervicalmyelopathy[J].Spine J,2014,14(6):909-915.doi:10.1016/j.spinee.2013.07.445.
[7]Komagata M,Nishiyama M,Endoh K,et al.Clinical study of thepost operative C5 palsy after cervical expansive laminoplasty;Efficacy of bilateral partial foraminotomy for the prevention the C5palsy(in Japanese)[J].J Jpn Spine Res Soc,2002,131:237.
[8]Gu Y,Cao P,Gao R,et al.Incidence and risk factors of C5 palsyfollowing posterior cervical decompression:a systematic review[J].PLo S One,2014,9(8):e101933.doi:10.1371/journal.pone.0101933.e Collection2014.
[9]Katsumi K,Yamazaki A,Watanabe K,et al.Can prophylacticbilateral C4/5 foraminotomy prevent postoperative C5 palsy afteropen-door laminoplasty:a prospective study[J].Spine(Phila Pa1976),2012,37:748-754.
[10]王少波,蔡钦林,党耕町,等.单开门颈椎管扩大术后第五颈神经根麻痹[J].中华骨科杂志,1999,19(12):716-718.Wang SB,Cai QL,Dang GT,et al.Palsy of the C5 nerve root as acomplicaiton after expansive open-door laminoplasty of thecervical spine[J].Chin J Orthop,1999,19(12):716-718.
[11]Mitchell R,Klement MD,Lindsay T,et al.C5 palsy after cervicallaminectomy and fusion:does width of laminectomy matter?[J].Spine J,2016,16(4):462-467.doi:10.1016/j.spinee.2015.07.437.