中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2014年
12期
40-43
,共4页
颈椎病%椎板切除术%神经根麻痹
頸椎病%椎闆切除術%神經根痳痺
경추병%추판절제술%신경근마비
Cervical spondylosis%Laminectomy%Radiculopathy
目的 分析颈后路单开门椎管成形术与椎板切除内固定术治疗多节段脊髓型颈椎病术后C5神经根麻痹的发生率及其原因.方法 2008年1月至2012年8月因多节段脊髓型颈椎病分别接受椎管成形术的患者47例(A组)、接受椎板切除内固定术的患者51例(B组),术后随访13～56(26.5±7.9)个月.手术前后分别测量颈椎前凸角度、颈椎曲度指数(CCI),并记录术后C5神经根麻痹的发生情况.结果 A组C5神经根麻痹发生率明显低于B组[2.1％(1/47)比21.6％(11/51)],差异有统计学意义(x2=5.430,P＜0.05).A、B组手术前后日本整形外科学会(JOA)评分和术后JOA评分改善率比较差异均无统计学意义(P＞0.05).各组手术前后颈椎前凸角度及CCI比较差异无统计学意义(P＞0.05).A组和B组CCI改变率比较差异无统计学意义(P＞0.05).B组中发生C5神经根麻痹11例作为B1组,另40例为B2组.B1组术后CCI改变率要明显大于B2组[(38.7±18.3)％比(22.1±12.1)％],差异有统计学意义(t=1.772,P＜0.05).结论 相比颈后路椎板切除内固定术,椎管成形术后C5神经根麻痹发生率低.C5神经根麻痹可能与颈后路术后颈椎前凸增加有关.神经根拴系效应是其重要的发病机制之一.
目的 分析頸後路單開門椎管成形術與椎闆切除內固定術治療多節段脊髓型頸椎病術後C5神經根痳痺的髮生率及其原因.方法 2008年1月至2012年8月因多節段脊髓型頸椎病分彆接受椎管成形術的患者47例(A組)、接受椎闆切除內固定術的患者51例(B組),術後隨訪13～56(26.5±7.9)箇月.手術前後分彆測量頸椎前凸角度、頸椎麯度指數(CCI),併記錄術後C5神經根痳痺的髮生情況.結果 A組C5神經根痳痺髮生率明顯低于B組[2.1％(1/47)比21.6％(11/51)],差異有統計學意義(x2=5.430,P＜0.05).A、B組手術前後日本整形外科學會(JOA)評分和術後JOA評分改善率比較差異均無統計學意義(P＞0.05).各組手術前後頸椎前凸角度及CCI比較差異無統計學意義(P＞0.05).A組和B組CCI改變率比較差異無統計學意義(P＞0.05).B組中髮生C5神經根痳痺11例作為B1組,另40例為B2組.B1組術後CCI改變率要明顯大于B2組[(38.7±18.3)％比(22.1±12.1)％],差異有統計學意義(t=1.772,P＜0.05).結論 相比頸後路椎闆切除內固定術,椎管成形術後C5神經根痳痺髮生率低.C5神經根痳痺可能與頸後路術後頸椎前凸增加有關.神經根拴繫效應是其重要的髮病機製之一.
목적 분석경후로단개문추관성형술여추판절제내고정술치료다절단척수형경추병술후C5신경근마비적발생솔급기원인.방법 2008년1월지2012년8월인다절단척수형경추병분별접수추관성형술적환자47례(A조)、접수추판절제내고정술적환자51례(B조),술후수방13～56(26.5±7.9)개월.수술전후분별측량경추전철각도、경추곡도지수(CCI),병기록술후C5신경근마비적발생정황.결과 A조C5신경근마비발생솔명현저우B조[2.1％(1/47)비21.6％(11/51)],차이유통계학의의(x2=5.430,P＜0.05).A、B조수술전후일본정형외과학회(JOA)평분화술후JOA평분개선솔비교차이균무통계학의의(P＞0.05).각조수술전후경추전철각도급CCI비교차이무통계학의의(P＞0.05).A조화B조CCI개변솔비교차이무통계학의의(P＞0.05).B조중발생C5신경근마비11례작위B1조,령40례위B2조.B1조술후CCI개변솔요명현대우B2조[(38.7±18.3)％비(22.1±12.1)％],차이유통계학의의(t=1.772,P＜0.05).결론 상비경후로추판절제내고정술,추관성형술후C5신경근마비발생솔저.C5신경근마비가능여경후로술후경추전철증가유관.신경근전계효응시기중요적발병궤제지일.
Objective To compare the incidence of C5 nerve root palsy after laminoplasty and laminectomy with internal fixation for treating multilevel cervical spondylotic myelopathy (MCSM).Methods From January 2008 to August 2012,98 patients with MCSM were treated with laminoplasty (47 patients,group A) or laminectomy (51 patients,group B) with internal fixation.All the patients were followed up for 13-56(26.5 ± 7.9) months.In both groups,Cobb's method was applied to measure cervical lordotic angle,and Ishihara's method was conducted to measure cervical curvature index (CCI) before and after operation.The incidence of C5 nerveroot palsy was recorded and compared.Results The incidence of C5 nerve root palsy in group A was 2.1％ (1/47),while 21.6 ％ (11/51) in group B (x2 =5.430,P ＜ 0.05).The JOA scores in group A and group B before and after operation and improvement rate of JOA scores had no significant difference (P＞ 0.05).The cervical lordotic angle and CCI in group A and group B before and after operation had no significant difference (P ＞ 0.05).The improvement rate of CCI between two groups had no significant difference (P ＞ 0.05).All of 11 patients with C5 nerve root palsy were group B 1,and other 40 patients were group B2.The improvement rate of CCI in group B1 was significantly higher than that in group B2 [(38.7 ± 18.3)％ vs.(22.1 ± 12.1)％](t =1.772,P＜ 0.05).Conclusions Compared with laminoplasty,laminectomy with internal fixation has a higher incidence of C5 nerve root palsy.The C5 nerve root palsy may be associated with postoperative increase of cervical lordosis angle.Moreover,tethering of the C5 root may he one of its important pathomechanisms.
